PMC:7381711 / 19171-21053 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7381711","sourcedb":"PMC","sourceid":"7381711","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7381711","text":"CONCLUSIONS\nThere is a paucity of pharmacologic therapies for COVID-19. Although heparin may prove beneficial in treating the coagulopathy of this disease, utilization of therapeutic anticoagulation before the development of thrombosis in COVID-19 has not been systematically evaluated. Additionally, although heparin is known to possess non-anticoagulant effects that may be beneficial in COVID-19 (i.e., direct antiviral and anti-inflammatory), the balance between its benefits and risks should be considered. Given the potential benefits (and uncertain risks) of therapeutic heparin (see Fig. 3), tempered by the failures of previous studies targeting coagulopathy in critical illness, randomized clinical trials of heparin in COVID-19 are urgently needed.\nFig. 3. Summary of potential therapeutic effects of heparin in coronavirus disease 2019 (COVID-19). 1) Heparin’s classic function as an anticoagulant, through its interaction with antithrombin-III (AT3), may prove beneficial because of the high prevalence of coagulopathy and clinically significant thrombosis in the disease. 2) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into both endothelial and epithelial cells is believed to be dependent on its interaction with cell surface heparan sulfate; thus, heparin (or carefully designed synthetic heparin-like drugs) may inhibit this interaction and block viral entry. 3) Last, heparin has known anti-inflammatory effects that may confer benefit in COVID-19. This illustration was created with BioRender (https://biorender.com/). ACE2, angiotensin-converting enzyme 2; APC, activated protein C; HS, heparan sulfate; IL, interleukin; PAI-1, plasminogen activator inhibitor 1; TF, tissue factor; TFPI, tissue factor pathway inhibitor; TNF, tumor necrosis factor; tPA, tissue plasminogen activator; uPA, urokinase plasminogen activator, VII, factor 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