The role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection
DOI:
https://doi.org/10.14739/2310-1210.2025.1.316504Keywords:
COVID-19, SARS-CoV-2, pneumonia, anticoagulant, unfractionated heparin, low-molecular-weight heparinAbstract
The review article focuses on the role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection. Considerable research interest in determining the role of anticoagulants, especially heparin, in COVID-19 patients is related to their positive effect on the disease course. Apart from well-known anticoagulant effects of unfractionated and low-molecular-weight heparins, they possess excellent pleiotropic properties. Although recommended, standard pharmacological thromboprophylaxis for hospitalized patients is debatable as there is still an issue regarding regimens and dosage in critically ill patients with pneumonia combined with COVID-19.
Aim. To define the role of anticoagulants in the treatment of community-acquired pneumonia in patients combined with coronavirus infection.
Materials and methods. Scientometric databases (PubMed, Web of Science and Scopus) were searched to retrospectively analyze literary sources focused on the specified issue selecting the most relevant ones for the period 2020–2024. Following evaluation of abstracts and full texts, 41 sources were retrieved.
Results. The pathogenesis of coagulopathy associated with COVID-19 is complex. It involves macrophage activation, the onset of “cytokine storm”, increased platelet adhesion and endothelial dysfunction, ultimately activating the intrinsic and extrinsic coagulation pathways. There is an increased risk of thromboembolism associated with COVID-19, and prophylactic anticoagulation improves outcomes in hospitalized patients. The problem for physicians is to decide which anticoagulant and how to start anticoagulation. Anticoagulant selection should take into consideration not only biochemical and coagulation parameters, such as elevated D-dimer, fibrinogen, and low antithrombin, which are the targets of this therapy. It is also extremely important to take into account bleeding risks, as massive bleeding can occur in 2.3 % of all patients, even when using standard doses for thromboprophylaxis. The use of anticoagulants such as heparin and vitamin K antagonists in COVID-19 patients is a challenging issue that depends on the balance between therapeutic benefit and potential risk avoidance. Therefore, thromboprophylaxis is indispensable for hospitalized patients with COVID-19.
Conclusions. Thus, the literature analysis has shown anticoagulant therapy as an integral component in the treatment of community-acquired pneumonia in patients combined with coronavirus infection for thromboprophylaxis. Heparin has been found to have a high therapeutic potential in patients with community-acquired pneumonia combined with coronavirus infection, but the bleeding risk should be weighed up. Enoxaparin is proved to be a safer anticoagulant option compared to heparin, but it may be not sufficiently effective in patients with community-acquired pneumonia combined with coronavirus infection.
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