From the Guidelines
The recommended treatment for post-COVID endothelial and glycocalyx dysfunction includes a multi-faceted approach targeting vascular repair and inflammation reduction, with a focus on anticoagulation and antiplatelet therapy as suggested by the American College of Chest Physicians expert panel report 1.
Key Components of Treatment
- Anticoagulants, such as low-dose aspirin 81mg daily, to prevent microthrombi formation
- Antiplatelet therapy, such as dual antiplatelet therapy (DAPT) for patients with confirmed acute coronary syndrome (ACS) 1
- Statins, such as atorvastatin 10-20mg daily, to support endothelial health
- Antioxidants, such as N-acetylcysteine 600mg twice daily, to reduce inflammation
- Sulodexide (250-500 LSU twice daily) may be prescribed specifically for glycocalyx repair
Additional Considerations
- Vitamin D3 (2000-4000 IU daily), vitamin C (500-1000mg daily), and omega-3 fatty acids (1-2g daily) can support endothelial health
- Treatment duration typically ranges from 3-6 months, with monitoring of symptoms and vascular function
- The American Society of Hematology living guidelines on use of anticoagulation for thromboprophylaxis for patients with COVID-19 suggest prophylactic-intensity over therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness 1
- The 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults recommends consideration of follow-up testing (eg, ECG, echocardiogram, ambulatory rhythm monitor, CMR) 3-6 months after presentation, particularly in those with ongoing cardiac symptoms and/or findings suggestive of significant/worsening myocardial involvement 1
From the Research
Endothelial and Glycocalyx Dysfunction in Post-COVID Patients
- Endothelial dysfunction is a common feature of COVID-19, which may lead to impaired organ perfusion and a procoagulatory state resulting in both macro- and microvascular thrombotic events 2.
- The endothelial dysfunction in COVID-19 may be caused by the infection of vascular endothelial cells by SARS-CoV-2, and evidence of widespread endothelial injury and inflammation is found in advanced cases of COVID-19 2.
- Post-COVID endothelial and glycocalyx dysfunction may be associated with impaired vascular function, myocardial deformation, and oxidative stress, which can persist for months after infection 3.
Recommended Treatment for Post-COVID Endothelial and Glycocalyx Dysfunction
- ACE inhibitors, angiotensin receptor blockers (ARBs), and statins are known to improve endothelial dysfunction and may be beneficial in COVID-19 patients 2, 4.
- Atorvastatin has been associated with reduced mortality in COVID-19 patients, and consideration should be given to its use as a treatment strategy 4.
- However, a pilot study found that targeting endothelial dysfunction with a combination of nicorandil, L-arginine, folate, nebivolol, and atorvastatin did not decrease time to recovery in hospitalized COVID-19 patients 5.
- Further studies are needed to recommend the use of ACEIs, ARBs, and other medications as a treatment strategy for post-COVID endothelial and glycocalyx dysfunction.
Biomarkers and Mechanisms of Endothelial Dysfunction in COVID-19
- Biomarkers such as perfused boundary region (PBR), flow-mediated dilatation (FMD), coronary flow reserve (CFR), pulse wave velocity (PWV), and global left and right ventricular longitudinal strain (GLS) can be used to assess endothelial function in COVID-19 patients 3.
- Oxidative stress markers such as malondialdehyde (MDA) and thrombomodulin can also be used to assess endothelial dysfunction in COVID-19 patients 3.
- The mechanisms of endothelial dysfunction in COVID-19 are complex and involve multiple pathways, including reduced nitric oxide bioavailability, oxidative stress, endothelial injury, and inflammation 6.