Semin Thromb Hemost
DOI: 10.1055/s-0040-1722293
Commentary

Relevance of Heparan Sulfate and Heparanase to Severity of COVID-19 in the Elderly

Yona Nadir
1  Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
2  The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
,
Benjamin Brenner
1  Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
2  The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
› Author Affiliations

The prevalence of arterial and venous thrombosis markedly rises with age. The annual rate of venous thromboembolism (VTE) is estimated at 1/100 patients above 80 years of age.[1] While aging is associated with some changes in the levels of coagulation proteins[2] and activation markers,[3] this does not explain the exponential increase in VTE risk observed in octogenarians.

Accordingly, such findings may be attributed to several factors. It has been recently demonstrated that coagulant activity under flow is mainly controlled by residual tissue factor (TF)/collagen and endothelial glycocalyx.[4] Given that the vessel wall is a major player in hemostasis, endothelial dysfunction, which increases with age, likely contributes to the development of thrombosis in cardiovascular diseases. Rapidly growing evidence links particulate air pollution exposure with an increased risk of respiratory and cardiovascular disease.[5] In the coronavirus disease 2019 (COVID-19) pandemic, the elderly are particularly vulnerable to severe vascular complications, including deep vein thrombosis and pulmonary embolism. This population appears to be particularly exposed in certain densely populated and air-polluted urban areas.



Publication History

Publication Date:
11 January 2021 (online)

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