key: cord-0690696-3wd7xefm
authors: Hasslocher-Moreno, Alejandro Marcel
title: Re: “Immunothrombotic dysregulation in chagas disease and COVID‑19: a comparative study of anticoagulation”
date: 2022-01-20
journal: Mol Cell Biochem
DOI: 10.1007/s11010-022-04361-z
sha: 33c25043642a58feeddb181fa54cab3ad2dca4f4
doc_id: 690696
cord_uid: 3wd7xefm

nan

Chagas cardiomyopathy is the most important clinical manifestation of Chagas disease, resulting in the majority of Chagas morbidity and mortality [4] . Also, in Chagas cardiomyopathy, the risk of thromboembolism is four times greater than in cardiomyopathy of other etiologies [5] and is responsible for 10 to 15% of the causes of death [6] . Mayoral et al. cite a retrospective study of Chagas' heart disease in which a review of 1,345 autopsy reports was performed, which identified cardiac thrombosis or thromboembolic phenomena in 44% of cases [7] . It is important to clarify that this prevalence of thrombogenic alterations occurs in CD with cardiopathy, while the indeterminate and digestive form are not related to thromboembolic events.

Our understanding is that the authors did not take into account the various clinical forms of the disease and the specific pathophysiological mechanisms involved in each one of them. They treated Chagas disease as if it were a single clinical entity and, therefore, it seems wrong to recommend immediate treatment of Chagas disease with anticoagulant drugs as mentioned in the conclusion of the study. This use of anticoagulants must be indicated in patients with Chagas' heart disease and high risk of thromboembolism. Predictive model of incidence of the cardioembolic ischemic stroke in Chagas disease has been defined, and the presence of electrocardiographic and echocardiographic alterations, such as primary alteration of the ventricular repolarization, systolic dysfunction, apical aneurysm, and age > 48 years, is an important predictor of stroke [5] . Therefore, these are the patients who would benefit from the strategy for the immediate treatment anticoagulant drugs. Moreover, in the heart Chagas disease, there are already guidelines and clinical protocols that deal with indication of anticoagulants as primary prophylaxis, particularly to prevent stroke [5] .

Author contributions AMHM wrote the Letter to the editor. Data availability My manuscript has no associated data.

Immunothrombotic dysregulation in chagas disease and COVID-19: a comparative study of anticoagulation

Chagas disease

Guía para el diagnóstico y el tratamiento de la enfermedad de Chagas

Chagas cardiomyopathy: an update of current clinical knowledge and management: a scientific statement from the American Heart Association

Prevention strategies of cardioembolic ischemic stroke in chagas' disease

Chagas disease

Cardiac thrombosis and thromboembolism in chronic chagas' heart disease

Ethical approval Not applicable.