Tags

Type your tag names separated by a space and hit enter

In vitro hypercoagulability and ongoing in vivo activation of coagulation and fibrinolysis in COVID-19 patients on anticoagulation.
J Thromb Haemost. 2020 Aug 06 [Online ahead of print]JT

Abstract

BACKGROUND

COVID-19 is associated with a substantial risk of venous thrombotic events, even in the presence of adequate thromboprophylactic therapy.

OBJECTIVES

We aimed to better characterize the hypercoagulable state of COVID-19 patients in patients receiving anticoagulant therapy.

METHODS

We took plasma samples of 23 patients with COVID-19 who were on prophylactic or intensified anticoagulant therapy. Twenty healthy volunteers were included to establish reference ranges.

RESULTS

COVID-19 patients had a mildly prolonged prothrombin time, high von Willebrand factor levels and low ADAMTS13 activity. Most rotational thromboelastometry parameters were normal, with a hypercoagulable maximum clot firmness in part of the patients. Despite detectable anti-activated factor X activity in the majority of patients, ex vivo thrombin generation was normal, and in vivo thrombin generation elevated as evidenced by elevated levels of thrombin-antithrombin complexes and D-dimers. Plasma levels of activated factor VII were lower in patients, and levels of the platelet activation marker soluble CD40 ligand were similar in patients and controls. Plasmin-antiplasmin complex levels were also increased in patients despite an in vitro hypofibrinolytic profile.

CONCLUSIONS

COVID-19 patients are characterized by normal in vitro thrombin generation and enhanced clot formation and decreased fibrinolytic potential despite the presence of heparin in the sample. Anticoagulated COVID-19 patients have persistent in vivo activation of coagulation and fibrinolysis, but no evidence of excessive platelet activation. Ongoing activation of coagulation despite normal to intensified anticoagulant therapy indicates studies on alternative antithrombotic strategies are urgently required.

Authors+Show Affiliations

Anesthesiology Department, Hospital Clínic, Institute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Anesthesiology Department, Hospital Clínic, Institute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.Anesthesiology Department, Hospital Clínic, Institute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.Anesthesiology Department, Hospital Clínic, Institute d'Investigacions Biomèdica Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.Department of Hemostasis, Hospital Clínic, Agustí Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32762118

Citation

Blasi, Annabel, et al. "In Vitro Hypercoagulability and Ongoing in Vivo Activation of Coagulation and Fibrinolysis in COVID-19 Patients On Anticoagulation." Journal of Thrombosis and Haemostasis : JTH, 2020.
Blasi A, von Meijenfeldt FA, Adelmeijer J, et al. In vitro hypercoagulability and ongoing in vivo activation of coagulation and fibrinolysis in COVID-19 patients on anticoagulation. J Thromb Haemost. 2020.
Blasi, A., von Meijenfeldt, F. A., Adelmeijer, J., Calvo, A., Ibañez, C., Perdomo, J., Reverter, J. C., & Lisman, T. (2020). In vitro hypercoagulability and ongoing in vivo activation of coagulation and fibrinolysis in COVID-19 patients on anticoagulation. Journal of Thrombosis and Haemostasis : JTH. https://doi.org/10.1111/jth.15043
Blasi A, et al. In Vitro Hypercoagulability and Ongoing in Vivo Activation of Coagulation and Fibrinolysis in COVID-19 Patients On Anticoagulation. J Thromb Haemost. 2020 Aug 6; PubMed PMID: 32762118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vitro hypercoagulability and ongoing in vivo activation of coagulation and fibrinolysis in COVID-19 patients on anticoagulation. AU - Blasi,Annabel, AU - von Meijenfeldt,Fien A, AU - Adelmeijer,Jelle, AU - Calvo,Andrea, AU - Ibañez,Cristina, AU - Perdomo,Juan, AU - Reverter,Juan C, AU - Lisman,Ton, Y1 - 2020/08/06/ PY - 2020/06/11/received PY - 2020/07/08/revised PY - 2020/08/03/accepted PY - 2020/8/8/pubmed PY - 2020/8/8/medline PY - 2020/8/8/entrez KW - COVID-19 KW - anticoagulation KW - coagulation KW - fibrinolysis JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. N2 - BACKGROUND: COVID-19 is associated with a substantial risk of venous thrombotic events, even in the presence of adequate thromboprophylactic therapy. OBJECTIVES: We aimed to better characterize the hypercoagulable state of COVID-19 patients in patients receiving anticoagulant therapy. METHODS: We took plasma samples of 23 patients with COVID-19 who were on prophylactic or intensified anticoagulant therapy. Twenty healthy volunteers were included to establish reference ranges. RESULTS: COVID-19 patients had a mildly prolonged prothrombin time, high von Willebrand factor levels and low ADAMTS13 activity. Most rotational thromboelastometry parameters were normal, with a hypercoagulable maximum clot firmness in part of the patients. Despite detectable anti-activated factor X activity in the majority of patients, ex vivo thrombin generation was normal, and in vivo thrombin generation elevated as evidenced by elevated levels of thrombin-antithrombin complexes and D-dimers. Plasma levels of activated factor VII were lower in patients, and levels of the platelet activation marker soluble CD40 ligand were similar in patients and controls. Plasmin-antiplasmin complex levels were also increased in patients despite an in vitro hypofibrinolytic profile. CONCLUSIONS: COVID-19 patients are characterized by normal in vitro thrombin generation and enhanced clot formation and decreased fibrinolytic potential despite the presence of heparin in the sample. Anticoagulated COVID-19 patients have persistent in vivo activation of coagulation and fibrinolysis, but no evidence of excessive platelet activation. Ongoing activation of coagulation despite normal to intensified anticoagulant therapy indicates studies on alternative antithrombotic strategies are urgently required. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32762118/In_vitro_hypercoagulability_and_ongoing_in_vivo_activation_of_coagulation_and_fibrinolysis_in_COVID-19_patients_on_anticoagulation L2 - https://doi.org/10.1111/jth.15043 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.