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2020 ; 4
(5
): 774-788
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Antiviral anticoagulation
#MMPMID32685886
Pryzdial ELG
; Sutherland MR
; Lin BH
; Horwitz M
Res Pract Thromb Haemost
2020[Jul]; 4
(5
): 774-788
PMID32685886
show ga
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel envelope
virus that causes coronavirus disease 2019 (COVID-19). Hallmarks of COVID-19 are
a puzzling form of thrombophilia that has elevated D-dimer but only modest
effects on other parameters of coagulopathy. This is combined with severe
inflammation, often leading to acute respiratory distress and possible lethality.
Coagulopathy and inflammation are interconnected by the transmembrane receptor,
tissue factor (TF), which initiates blood clotting as a cofactor for factor VIIa
(FVIIa)-mediated factor Xa (FXa) generation. TF also functions from within the
nascent TF/FVIIa/FXa complex to trigger profound changes via protease-activated
receptors (PARs) in many cell types, including SARS-CoV-2-trophic cells.
Therefore, aberrant expression of TF may be the underlying basis of COVID-19
symptoms. Evidence suggests a correlation between infection with many virus types
and development of clotting-related symptoms, ranging from heart disease to
bleeding, depending on the virus. Since numerous cell types express TF and can
act as sites for virus replication, a model envelope virus, herpes simplex virus
type 1 (HSV1), has been used to investigate the uptake of TF into the envelope.
Indeed, HSV1 and other viruses harbor surface TF antigen, which retains clotting
and PAR signaling function. Strikingly, envelope TF is essential for HSV1
infection in mice, and the FXa-directed oral anticoagulant apixaban had
remarkable antiviral efficacy. SARS-CoV-2 replicates in TF-bearing epithelial and
endothelial cells and may stimulate and integrate host cell TF, like HSV1 and
other known coagulopathic viruses. Combined with this possibility, the features
of COVID-19 suggest that it is a TFopathy, and the TF/FVIIa/FXa complex is a
feasible therapeutic target.