Abstract Number: PB0232
Meeting: ISTH 2021 Congress
Background: Coagulopathy has been reported in severe coronavirus disease 2019 (COVID-19) but its pathogenesis remains elusive.
Aims: We assessed the inflammation, endothelial and haemostatic markers including IL-6 and Tumor Necrosis Factor-a (TNF-a), Tissue Factor (TF), von Willebrand Factor (VWF), and Tissue Factor Pathway Inhibitor (TFPI) as a natural anticoagulant known to attenuate inflammation and vascular thrombosis, and DD, thrombin antithrombin complex (TAT), Fibrinogen (Fib), and Platelet Factor 4 (PF4) and b-Thromboglobulin (b-TG).
Methods: We prospectively enrolled 100 severe (60 men, 40 women; mean age 51 years, 32-60) and 60 mild/asymptomatic (40 men, 20 women; mean age 50 years, 31-59) patients COVID-19 reverse transcription polymerase chain reaction (RT-PCR)-confirmed cases. Severe COVID-19 patients had fever, respiratory symptoms and viral pneumonia on computed tomography scan (CT) receiving mechanical ventilation. Our management protocol included antithrombotic prophylaxis with 40 to 60 mg of enoxaparin per day and empirical antimicrobial treatment and antiviral therapy and corticosteroid during the course of hospitalization. IL-6 and TNF-a were measured using multiplex bead array, TF, VWF and TFPI and PF4 and β-TG by ELISA.
Results: Severe COVID-19 had elevated IL-6 and TNF-a, and TF, VWF and TFPI (50±10 pg/ml and 40±5 pg/ml and 2000±400 pg/ml, 390±50% and 176±60 ng/ml) compared with mild/asymptomatic COVID-19 (4±1pg/ml and 8±2 pg/ml and 19±2 pg/ml, 51±8% and 74±10 ng/ml) as well as DD, TAT and Fib (540±100 mg/l, 72±10 mg/l and 610±20mg/dl) compared with mild/asymptomatic COVID-19 (59±5mg/l, 2±1mg/l and 175±10 mg/l) and PF4 and b-TG (160±63 IU/ml and 250±16 IU/ml) compared with mild/asymptomatic COVID-19 (3±2 UI/ml and 9±5 IU/ml).
A positive correlation there was between studied parameters (p < .05).
Conclusions: These findings demonstrate that severe COVID-19 has profound inflammation associated to severe endotheliopathy leading increased uncontrolled TFPI haemostatic activity.
To cite this abstract in AMA style:Cacciola R, Gentilini Cacciola E, Vecchio V, Cacciola E. Coagulopathy in Patients with Severe COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/coagulopathy-in-patients-with-severe-covid-19/. Accessed December 10, 2023.
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