Anticoagulants in covid-19 therapy: An evidence-based review

The novel coronavirus disease 2019 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has affected humans globally and has led to significant morbidity and mortality The virus is believed to be transferred from bats and most commonly affects the respiratory system, lungs as the primary site of infection The patients can have a varied presentation from being asymptomatic to develop acute lung injury worsening to respiratory failure and even multiorgan failure leading to death The novel nature of the virus is the reason for the absence of prior immunity and has ended up in a huge surge of cases globally The clinical presentation of COVID-19 has been evolving as the number of cases increasing and hence the plan of treatment also keeps on modifying The classical symptoms include fever, dry cough, tiredness, and sometimes can also have nasal congestion, headache, conjunctivitis, sore throat, diarrhoea rash on the skin, anosmia, hyposmia, ageusia, and dysgeusia COVID-19 has also been seen to be associated with coagulopathy because of a prothrombotic state in the venous and arterial circulations which can be due to SARS-CoV-2 induced inflammation, dysregulation of the coagulation cascade, platelet activation and endothelial dysfunction The presentation can mimic the patients with disseminated intravascular coagulopathy and the initial stage mostly presents with an elevation of D-dimer and fibrin degradation products Primary screening of the coagulation profile is suggested along with the estimation of D-dimer and fibrinogen levels to assist in early recognition of the high-risk patients and also predict prognosis Early diagnosis and intervention with anti-coagulants can improve prognosis and associated complications This article reviews the epidemiology, pathogenesis, presentation, and management of the abnormal coagulation findings related to COVID-19