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Oral Anticoagulation Reversal Learning Zone


Read time: 20 mins
Published:20th Jun 2020
Emerging evidence is revealing that severe coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities and an increased risk of venous thromboembolism. Could patients with severe cases of COVID-19 benefit from anticoagulant therapy?

As we progress through the COVID-19 pandemic, research into the pathogenesis of the SARS-CoV-2 virus has revealed a complex range of symptoms associated with the disease. Recently, evidence has been mounting that a significant proportion of patients with severe COVID-19 have coagulation abnormalities. Studies from the Netherlands and France have even suggested that blood clots may arise in as many as 20-30% of critically ill COVID-19 patients (Klok et al., 2020; Poissy et al., 2020).

So why would an infection of the respiratory tract cause blood clots? Could anticoagulants increase COVID-19 survival?

Although patients with COVID-19 primarily have a respiratory tract infection, new research is beginning to reveal that patients with severe COVID-19 may have coagulation abnormalities that can cause an increased risk of death (Tang et al, 2020a).

Within the complex interplay of factors present in coagulation, the formation of D-dimer proteins after the fibrinolysis of blood clots has proven to be a powerful predictor of mortality in patients hospitalised with COVID-19 (Zhang et al, 2020).

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Research has found blood clots in small vessels of people with severe COVID-19 (Magro et al., 2020) and a recent observational study found that systemic anticoagulation is associated with improved outcomes among patients hospitalised with COVID-19 and on mechanical ventilation (Paranjpe et al., 2020). 

This was also seen in another study where significant coagulopathy correlated with disease severity and a reduced intravascular coagulation with thromboprophylaxis (Fogarty et al., 2020).

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While scientists are continually working to find new vaccines, improve testing and understand the pathogenesis of the disease, research is being carried out to build a clearer picture of how clotting occurs in people with COVID-19.

Currently, the utility of anticoagulation therapy and the appropriate level of dosing is still a matter of hot debate. Various novel anticoagulants developed over the years for a wide variety of targets, yet little research has so far been carried out to determine the best anticoagulants for treating COVID-19 associated blood clotting.

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