The Role of Heparin in Postural Orthostatic Tachycardia Syndrome and Other Post-Acute Sequelae of COVID-19

• Published in: Journal of clinical medicine Vol. 13; no. 8; p. 2405
• Main Authors: Gómez-Moyano, Elisabeth, Pavón-Morón, Javier, Rodríguez-Capitán, Jorge, Bardán-Rebollar, Daniel, Ramos-Carrera, Teresa, Villalobos-Sánchez, Aurora, Pérez de Pedro, Iván, Ruiz-García, Francisco J, Mora-Robles, Javier, López-Sampalo, Almudena, Pérez-Velasco, Miguel A, Bernal-López, Maria-Rosa, Gómez-Huelgas, Ricardo, Jiménez-Navarro, Manuel, Romero-Cuevas, Miguel, Costa, Francesco, Trenas, Alicia, Pérez-Belmonte, Luis M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.04.2024
• Subjects: Anticoagulants; Antigens; Antiviral agents; Biomarkers; Blood clot; Blood clotting disorders; Cardiac arrhythmia; Coronaviruses; COVID-19; Cytokine storm; Cytotoxicity; Drug therapy; Endothelium; Fondaparinux; Health aspects; Heparin; Hypoxia; Inflammation; Kinases; Lymphocytes; Meta-analysis; Neutrophils; Pathogenesis; Pathogens; Proteins; Pulmonary fibrosis; Risk factors; Severe acute respiratory syndrome coronavirus 2; Tachycardia; Thrombosis; Tumor necrosis factor-TNF; Spain; COVID-19; heparin; post-acute sequelae; microvascular thrombosis; postural orthostatic tachycardia syndrome
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13082405

The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, and persistent microvascular endotheliopathy that could trigger microvascular thrombosis. These elements have also been implicated in the physiopathology of postural orthostatic tachycardia syndrome, a frequent sequela in post-COVID-19 patients. These mechanisms, directly associated with post-acute sequelae, might determine the thrombotic consequences of COVID-19 and the need for early anticoagulation therapy. In this context, heparin has several potential benefits, including immunomodulatory, anticoagulant, antiviral, pro-endothelial, and vascular effects, that could be helpful in the treatment of COVID-19 post-acute sequelae. In this article, we review the evidence surrounding the post-acute sequelae of COVID-19 and the potential benefits of the use of heparin, with a special focus on the treatment of postural orthostatic tachycardia syndrome.