PT  - JOURNAL ARTICLE
AU  - Ricardo J. José
AU  - Andrew Williams
AU  - Ari Manuel
AU  - Jeremy S. Brown
AU  - Rachel C. Chambers
TI  - Targeting coagulation activation in severe COVID-19 pneumonia: lessons from bacterial pneumonia and sepsis
AID  - 10.1183/16000617.0240-2020
DP  - 2020 Sep 30
TA  - European Respiratory Review
PG  - 200240
VI  - 29
IP  - 157
4099  - http://err.ersjournals.com/content/29/157/200240.short
4100  - http://err.ersjournals.com/content/29/157/200240.full
SO  - EUROPEAN RESPIRATORY REVIEW2020 Sep 30; 29
AB  - Novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has rapidly spread throughout the world, resulting in a pandemic with high mortality. There are no effective treatments for the management of severe COVID-19 and current therapeutic trials are focused on antiviral therapy and attenuation of hyper-inflammation with anti-cytokine therapy. Severe COVID-19 pneumonia shares some pathological similarities with severe bacterial pneumonia and sepsis. In particular, it disrupts the haemostatic balance, which results in a procoagulant state locally in the lungs and systemically. This culminates in the formation of microthrombi, disseminated intravascular coagulation and multi-organ failure. The deleterious effects of exaggerated inflammatory responses and activation of coagulation have been investigated in bacterial pneumonia and sepsis and there is recognition that although these pathways are important for the host immune response to pathogens, they can lead to bystander tissue injury and are negatively associated with survival. In the past two decades, evidence from preclinical studies has led to the emergence of potential anticoagulant therapeutic strategies for the treatment of patients with pneumonia, sepsis and acute respiratory distress syndrome, and some of these anticoagulant approaches have been trialled in humans. Here, we review the evidence from preclinical studies and clinical trials of anticoagulant treatment strategies in bacterial pneumonia and sepsis, and discuss the importance of these findings in the context of COVID-19.A large armamentarium of potentially beneficial anticoagulant agents exists, and well-designed randomised clinical trials are now needed to investigate the wide range of anticoagulant and anti-fibrinolytic therapies to determine the optimal strategy https://bit.ly/2CI459q