Heparin – an old drug with multiple potential targets in Covid‐19 therapy

Lindahl, Ulf; Li, Jin‐Ping

A prominent clinical feature of severe Covid‐19 infection is respiratory failure associated with pulmonary coagulopathy. Recent reports published in Thrombosis and Haemostasis show that treatment with low‐molecular weight heparin (LMWH) decreases mortality in critically ill patients with sepsis‐induced hypercoagulation, and thus argue for prophylactic administration of the anticoagulant. In addition, the authors point to non‐anticoagulant activities of heparin, in particular anti‐inflammatory effects with potential to prevent deterioration of the disease. We would like to use this opportunity to clarify the biochemical background of the diverse activities of heparin, and further, how this information may be exploited to generate more efficient treatment of the viral infection. Mechanisms to consider relate to the functional roles of proteins interacting with heparan sulfate (HS), a polysaccharide closely related to heparin.