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Von Willebrand Factor and ADAMTS13 Activity as Endothelial Injury Markers and their Prognostic Value in COVID-19

A. Marco1,2, P. Marco1,2,3

1University General Hospital in Alicante, Alicante, Spain, 2Biomedical Research Institute, Alicante, Spain, 3Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain

Abstract Number: PB0166

Meeting: ISTH 2021 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: The coronavirus disease 2019 (COVID-19) increases thrombotic risk. The mechanisms that lead to this prothrombotic state are unclear.

Aims: The main aim was to evaluate the von Willebrand factor (VWF) antigen and plasma ADAMTS13 activity as endothelial injury markers in COVID-19 and their prognostic value in COVID-19 evolution.

Methods: We present a prospective study in COVID-19 patients recruited in our institution. The patients were divided into 2 groups depending on whether hospitalization was needed. Inpatients were subclassified into ward patients and those requiring intensive care. Thirty non-COVID-19 inpatients and 30 non-COVID-19 healthy individuals were recruited. VWF antigen, ADAMTS13 activity, D-dimer, and fibrinogen were measured during the first week once COVID-19 was diagnosed. Quantitative data were expressed as median (p25-p75) and qualitative data as percentage.

Results: Fifty COVID-19 inpatients (44% in the intensive care unit [ICU]) and 102 COVID-19 outpatients were enrolled. Inpatients were older and had a higher incidence of hypertension and diabetes. The COVID-19 inpatients had higher D-dimer, fibrinogen, and VWF antigen levels and a lower ADAMTS13 activity compared with the COVID-19 outpatients (p<0.05). ICU patients had higher D-dimer and VWF antigen levels compared with the ward patients and the lowest ADAMTS13 activity (p<0.05). An imbalance in VWF antigen/ADAMTS13 activity ratio was observed in COVID-19, reaching the highest in ICU patients. In contrast to other acute inflammatory diseases, a significative reduction in ADAMTS13 activity was observed in all COVID-19 patients.

Table 1

Inpatients (n=50) Outpatients (n=102)
D-Dimer (µg/mL) 2.48 (0.88–6.86) 0.4 (0.27–0.56)
 p<0.05
Fibrinogen (mg/dL) 511 (395–568)
 
346.5 (291–374)
 p<0.05
ADAMTS13 activity (%) 44.4 (32.5–60.8) 59.9 (43.4–78.75)
 p<0.05
VWF antigen (%) 337.8 (270.0–394.9)
 
121.6 (95.75–151.95)
 p<0.05

Hemostatic parameters: inpatients versus outpatients
Table 2

Ward patients (n=28) ICU patients (n=22)
D-Dimer (µg/mL) 0.89 (0.73–2.31)
 
4.64 (2.66–11.04)
 p<0.05
Fibrinogen (mg/dL) 511 (383–561)
 
505 (400–576)
 p<0.05
ADAMTS13 activity(%) 46.5 (40.4–60.9) 38.85 (26–60)
 p<0.05
VWF antigen (%) 279.95 (217.15–345.15)
 
368.6 (336.3–400)
 p<0.05

Hemostatic parameters: ward patients versus ICU patients

Conclusions: There is an increase in VWF antigen and an ADAMTS13 activity reduction in COVID-19 related to disease severity and could predict poor clinical outcomes. The ADAMTS13 activity reduction could be a marker associated with COVID-19 in contrast to other inflammatory conditions.

To cite this abstract in AMA style:

Marco A, Marco P. Von Willebrand Factor and ADAMTS13 Activity as Endothelial Injury Markers and their Prognostic Value in COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/von-willebrand-factor-and-adamts13-activity-as-endothelial-injury-markers-and-their-prognostic-value-in-covid-19/. Accessed June 25, 2022.

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