Proinflammatory and Thrombotic Manifestations and the Therapeutic Options of COVID-19

Abstract

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2), has put the global health system into crisis. The complications of the disease include respiratory failure, proinflammatory, and thromboembolic presentations. It is being increasingly recognised that host response with the inflammatory and thrombotic state is responsible for the severity of the disease. Numerous studies are now showing that increased inflammatory markers like interleukin (IL) 6 portray a poor prognosis. Thrombo-embolic complications like pulmonary embolism also produce clinical deterioration in COVID 19. The management of the disease presently includes antiviral, anti-inflammatory, and anticoagulant therapy along with supportive care for respiratory complications. The therapeutic challenge is augmented due to the varied clinical presentations, rapid worsening, and lack of a clear understanding of the pathophysiology. The initial data regarding the treatment options are of low quality and are mostly from cohort analysis. Many randomised controlled trials (RCT) are ongoing, and the results from the RCTs will help in developing better treatment options. We discuss in this review the pathophysiology and mechanism behind the increased inflammation and thrombosis. We will also discuss the available therapeutics options and the recommendations of various guidelines regarding the management of the proinflammatory and thrombotic state.