Heparin - an old drug with multiple potential targets in Covid-19 therapy.

Published on May 19, 2020in Journal of Thrombosis and Haemostasis4.662
· DOI :10.1111/JTH.14898
Ulf Lindahl , Ulf Lindahl74
Estimated H-index: 74
(Uppsala University),
Jin-Ping Li38
Estimated H-index: 38
(Uppsala University)
A prominent clinical feature of severe Covid-19 infection is respiratory failure associated with pulmonary coagulopathy. Recent reports published in Thrombosis and Haemostasis show that treatment with low-molecular weight heparin (LMWH) decreases mortality in critically ill patients with sepsis-induced hypercoagulation, and thus argue for prophylactic administration of the anticoagulant. In addition, the authors point to non-anticoagulant activities of heparin, in particular anti-inflammatory effects with potential to prevent deterioration of the disease. We would like to use this opportunity to clarify the biochemical background of the diverse activities of heparin, and further, how this information may be exploited to generate more efficient treatment of the viral infection. Mechanisms to consider relate to the functional roles of proteins interacting with heparan sulfate (HS), a polysaccharide closely related to heparin.
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#1Jecko Thachil (University of Manchester)H-Index: 5
#1Jecko Thachil (University of Manchester)H-Index: 20
I thank Lindahl and Li for their thoughtful comments on the non-anticoagulant properties of heparin.1 Heightened awareness of hypercoagulability has made heparin part and parcel of the COVID-19 management algorithms. In addition, reports of prophylactic anticoagulation failure have triggered several trials where escalated doses of heparin are compared with standard doses with the aim of preventing thrombotic complications. At this juncture, we do need to consider where do the non-anticoagulant p...