IJCS | Volume 33, Nº4, July and August 2020

406 organ failure, disseminated intravascular hemorrhage/ coagulopathy, acute hepatic/renal heart injury and secondary bacterial infections. Consistent with clinical observations, the lungs are the organs that suffer the most damage, followed by moderate injury to heart, liver, kidney, and brain. Patients with high plasma/ plasminogen levels and pre-existing conditions seem to present a mechanism that contributes to increase the susceptibility to infection and fatality by the new coronavirus. Therefore, targeting hyperfibrinolysis with antiplasmin compounds (broad spectrum or specific) may prove to be a promising strategy to improve the clinical outcome of patients with comorbidities. Clinical trials with several protease inhibitors are being conducted in China; however, there are no suitable animal models of COVID-19 with underlying medical conditions to test new therapeutic agents. 10 In the fibrinolysis process, plasmin generates soluble D-dimer and D-monomer from the proteolytic cleavage of fibrin. The activity of this enzyme can be detected in bronchial-alveolar lavage (BAL), including in healthy individuals. However, significantly increased levels of D-dimer and D-monomer are found in patients with ARDS, who also have a higher expression of α2- antiplasmin, a specific plasmin inhibitor. Thus, while the fibrinolytic activity decreases by half, the level of D-dimer increases, showing a nonproportional change between the level of expression and activity of plasmin and antiplasmin in favor of fibrin degradation in ARDS patients. In addition, the literature points to a prominent reduction in platelets in individuals with COVID-19. Therefore, in this context, the idea that the administration of antiproteases can be beneficial is reinforced. On the other hand, based on laboratory and pathological results, hypercoagulation occurs, as evidenced by the presence of microthrombi along the blood vessels of multiple organs. It is not known whether fragmented hemorrhage coexists with areas 84 studies were identified in the search, with no time restrictions (MEDLINE, SCOPUS, LILACS) Associations between COVID-19 data and different CVDs (69) Associations between COVID-19 data and different pharmacological groups (15) Bleeding (6), stroke (3), thrombosis (1), arrhythmia (6), heart failure (8), hypertension (44), dyslipidemia (0), angina pectoris (0), coronary artery disease (1) Anticoagulants (5), diuretics (0), antihypertensives (10), beta-blockers (0), calcium channel blockers (0) Excluded because full texts were unavailable in English and/or Portuguese (2) Excluded after reading title and abstract (47) Excluded after reading full text (20) 15 articles selected for review Figure 1 – Flowchart of the selection process of the searched studies. The number of articles in each stage is indicated in parentheses. Pedro et al. Cardiovascular pharmacotherapy and covid-19 Int J Cardiovasc Sci. 2020; 33(4):404-411 Viewpoint