Another interesting aspect of how the SARS-CoV-2 virus may be influenced by the use of heparin as anticoagulant is the previous observation that FXa can cleave the spike protein of SARS-CoV to render it more efficient in invading cells.147 However, to date, this aspect remains to be investigated with SARS-CoV-2. These data have led some groups to propose specifically engineered heparins for the treatment of COVID-19, while clinical trials are underway to investigate the effects of low dose, and full-dose, anticoagulation with heparin on clinical outcomes for patients with COVID-19 (URL: https://www.clinicaltrials.gov. Unique identifiers: NCT04344756 and NCT04345848).142 It is important to note that given the potential for heparin therapeutics to cause heparin-induced thrombocytopenia, but reassuringly, despite both thrombocytopenia and thrombosis being common complications of COVID-19, the development of heparin-induced thrombocytopenia appears limited to individual case reports.148