Clot Waveform of APTT Has Abnormal Patterns in Subjects with COVID-19

Abstract

In Coronavirus disease 2019 (COVID-19) subjects, recent evidence suggests the presence of unique coagulation abnormalities. In this study, we performed clot waveform analyses to investigate whether specific modulations are observed in COVID-19 subjects. We analyzed the second derivative of the absorbance in routine APTT tests performed using an ACL-TOP system. We observed high frequencies of abnormal patterns in APTT second-derivative curves that could be classified into an early shoulder type, a late shoulder type, or a biphasic type, high maximum first-derivative and second-derivative peak levels, and a low minimum second-derivative peak level in COVID-19 subjects. These modulations were not observed in subjects with disseminated intravascular coagulation. These abnormal patterns are also observed in patients with lupus anticoagulant, hemophilia, or factor IX deficiency. The plasma fibrinogen levels might also be involved in the abnormal APTT waveforms, especially the high maximum first-derivative and second-derivative peak levels. The abnormal patterns in the APTT second-derivative curves appear with highest frequency at around 2 weeks after the onset of COVID-19 and were not associated with the severity of COVID-19. These results suggest the possible presence of a specific abnormal coagulopathy in COVID-19.

SARS‐CoV‐2 triggered oxidative stress and abnormal energy metabolism in gut microbiota

“…39 The clot waveform of APTT also suggested that COVID-19 patients might have distinctive abnormal coagulopathy. 40 High-level TIBIL is generally considered a marker of abnormal liver metabolism and hepatitis, 41 and there appears to be a significant relationship between HGB levels and COVID-19 disease severity. 42 These results suggested that enrolled COVID-19 patients may have liver damage, pathogen infection, and blood system disorder.…”

Urine sediment findings were milder in patients with COVID-19-associated renal injuries than in those with non-COVID-19-associated renal injuries

“…A recent study has shown that a high SARS-CoV-2 viral load is associated with renal complications and the severity of COVID-19 (Caceres et al, 2021). Complications such as thrombosis and endothelitis are also frequently observed in COVID-19 subjects (Li et al, 2020, Shimura et al, 2021, Xiong et al, 2020; theoretically, such complications could lead to renal impairment. In addition, other mechanisms not specific to COVID-19 have also been proposed.…”

SARS-CoV-2 triggered excessive inflammation and abnormal energy metabolism in gut microbiota

“…The clot waveform of APTT also suggested that COVID-19 patients might have distinctive abnormal coagulopathy [27]. High-level total bilirubin is generally considered a marker of abnormal liver metabolism and hepatitis, and there appears to be a significant relationship between hemoglobin levels and COVID-19 disease severity [28].…”