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The novel coronavirus is a coagulative disease with diffuse thrombosis of the vascular system: the fundamental role of the antithrombotic therapy.

Author: 
Palma Giampaolo, Imitazione Pasquale, Tarro Giulio, Polistina Giorgio Emanuele and Fiorentino Giuseppe
Subject Area: 
Health Sciences
Abstract: 

A key event in the evolution of the Covid-19 disease is represented by coagulation disorders and this is confirmed by more and more evidence and observations. Coagulopathy (CAC) associated with Covid-19 has been defined as a fulminant activation of coagulation, resulting from diffuse thrombosis, which falls within the ISTH criteria for Disseminated Intravascular Coagulation (DIC). Clinical evidence, laboratory tests, histological tests, and radiological techniques have confirmed that Covid-19 attacks not only directly the pulmonary parenchyma but is above all a "widespread systemic vascular disease affecting all organs" and not only the lungs. The coagulation disorders had already been hypothesized when in hospitalized patients, although increasing the pO2, respiratory performance did not improve because the lungs appeared "insensitive"; all this confirmed that there had to be another physio-pathological mechanism of the evolution of the disease in severe respiratory failure. The clinic chart at the patient entry to hospital for worsening dyspnea, chest pain, heart failure with evolution often in septic shock, accompanied by high coagulation indices at the entrance (D-dimer, PT, fibrinogen) and the numerous diagnoses of confirmed pulmonary thromboembolism from the chest CT Angio and numerous cardiac arrests for coronary syndromes and severe heart failure confirm the pathogenetic mechanism of hypercoagulation. The clinical manifestations of coagulation disease from Covid19 are : pulmonary thromboembolism in the lung; acute coronary syndromes (ACS) - heart failure and threatening arrhythmias in addition to heart myocarditis, stroke also in young patients with no brain comorbility, in vasculitis with increased prevalence of Kawasaki syndrome in children often asymptomatic and acute renal failures such as kidney damage and intestinal disorders such as damage to the small intestine. Therefore, therapies that have reduced considerable numbers statistically access to Intensive Care Unit (ICU) patients for assisted ventilation for severe respiratory insufficiency have proven to be the therapies that block a fundamental physio-pathological mechanism of Covid-19 disease, i.e. hyper-coagulation. and inflammation. As confirmed by the COVID departments in Italy, it was essential to block the storm of coagulation and inflammatory toxins with anticoagulants and steroids at therapeutic doses and administered at the right time to reduce access to ICU for patients. The COVID-19 disease is an endothelial disease; it is a systemic inflammation of the blood vessels that can generate serious micro-disturbances in the bloodstream and damage to the lungs, heart, brain, kidneys, and intestines. At the therapeutic level, this means that viral multiplication and inflammation must be combated but, at the same time, "it is of fundamental importance to protect the cardiovascular system of patients with drugs that act on hyper-coagulation".

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