Anticoagulation Strategy and Recent Developments in Therapeutics for Covid 19

Abstract

In December 2019, an outbreak of a new type of coronavirus was reported in Wuhan, China by a novel member of coronavirus genera which was officially named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) by the international committee for taxonomy of viruses based on phylogenetic analysis. It was believed to be a spillover of an animal coronavirus and later adapted ability of human to human transmission through mutation. The world health organization (WHO) termed the new virus 2019 novel coronavirus on 12 January 2020 and then officially named this disease as Coronavirus disease 2019 (Covid -19) on 12th January 2020. Severe acute respiratory syndrome Corona Virus-2 induced infection can be associated with coagulopathy and infection induced inflammatory changes in various internal organs with some features of disseminated intravascular coagulopathy. To reduce the viral load in the upper respiratory tract, repurposed antiviral drugs like Favipiravir and Remdesivir were tried initially and new molecules like Molnupiravir and Paxlovid have completed phase I trial and is found to be effective if given in the early part of the illness. Similarly, monocolonal antibodies like Bamlanivimab plus Etesevimab, Casirivimab and Imdevimab, Sotrovimab were also being given to block the entry of the virus into the respiratory epithelium and prevent the attachment of the virus to ACE II receptor leading to Covid 19 thrombo inflammation especially in older population (age > 60years) with comorbidities. Along with immunomodulator and immunosuppressant therapy, most important therapeutic intervention is early D-Dimer driven anticoagulation to prevent micro thrombi especially in the pulmonary and systemic circulation. As these modalaties of treatment are being practised in many parts of the world, it is worthwhile to review the present treatment protocol for Covid 19 infection as per the literature available at present.