Hemostatic alterations in COVID-19

Peyvandi, Flora; Artoni, Andrea; Novembrino, Cristina; Aliberti, Stefano; Panigada, Mauro; Boscarino, Marco; Gualtierotti, Roberta; Rossi, Federica; Palla, Roberta; Martinelli, Ida; Grasselli, Giacomo; Blasi, Francesco; Tripodi, Armando

doi:10.3324/haematol.2020.262634

Cited by 45 publications

(49 citation statements)

References 15 publications

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“…A high incidence of venous thromboembolic events in COVID‐19 patients, between 20% to 50% depending on the intensity of care and the severity of the clinical manifestations, was observed 5‐7,27‐30 . In agreement with others, we found a state of hypercoagulability driven by high factor VIII levels, and a perturbation of the endothelium, with elevated VWF and complement activation 3,4,22 . We thus decided to evaluate in more depth the role of VWF in COVID‐19 by assessing multiple biomarkers involved in a high shear microvessel environment, such as platelets, VWF antigen, VWF ristocetin‐cofactor activity, VWF multimeric pattern, VWF propeptide, and ADAMTS13, the VWF‐cleaving protease.…”

Section: Discussionsupporting

confidence: 73%

“…As previously shown in COVID-19 patients recruited at our institution in the frame of the COHERENT study, 22 median platelet counts were within the normal range (130-400 × 10 9 /L) in all study groups.…”

Section: Re Sultssupporting

confidence: 78%

“…We performed a cross‐sectional study of 50 COVID‐19 patients referred to the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan (Italy), between the beginning of March and mid‐April 2020 and enrolled in the COHERENT study of our institution (“COVID‐19: Hemostasis, Immune Response, Endothelial Perturbation and Complement [COHERENT]”, Ethics Committee approval by Comitato Etico Area 2, Milano (no. 360_2020), according to the Helsinki Declaration of 1964 revised in 2013) 22 . Patients were clinically diagnosed with COVID‐19 and tested positive for SARS‐CoV‐2 by real‐time reverse transcriptase polymerase chain reaction of nasopharyngeal swabs.…”

Section: Methodsmentioning

confidence: 99%

“…Previous work from our group demonstrated an elevated level of VWF in COVID‐19 patients, increasing with the severity of the disease 4,22 . The aim of the present study was to focus on the VWF‐ADAMTS13 axis to better understand the pathophysiology of microthrombosis in COVID‐19.…”

Section: Introductionmentioning

confidence: 93%

“…[19][20][21] Previous work from our group demonstrated an elevated level of VWF in COVID-19 patients, increasing with the severity of the disease. 4,22 The aim of the present study was to focus on the VWF-ADAMTS13 axis to better understand the pathophysiology of microthrombosis in COVID-19. To do so, we assessed the VWF multimeric pattern, the VWF propeptide, and ADAMTS13 levels in patients with different degrees of disease severity.…”

Section: Introductionmentioning

confidence: 99%

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The ADAMTS13‐von Willebrand factor axis in COVID‐19 patients

Mancini

Baronciani

Artoni

et al. 2021

Journal of Thrombosis and Haemostasis

197

233

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Background Severe coronavirus disease 2019 (COVID‐19) is characterized by an increased risk of thromboembolic events, with evidence of microthrombosis in the lungs of deceased patients. Objectives To investigate the mechanism of microthrombosis in COVID‐19 progression. Patients/Methods We assessed von Willebrand factor (VWF) antigen (VWF:Ag), VWF ristocetin‐cofactor (VWF:RCo), VWF multimers, VWF propeptide (VWFpp), and ADAMTS13 activity in a cross‐sectional study of 50 patients stratified according to their admission to three different intensity of care units: low (requiring high‐flow nasal cannula oxygenation, n = 14), intermediate (requiring continuous positive airway pressure devices, n = 17), and high (requiring mechanical ventilation, n = 19). Results Median VWF:Ag, VWF:RCo, and VWFpp levels were markedly elevated in COVID‐19 patients and increased with intensity of care, with VWF:Ag being 268, 386, and 476 IU/dL; VWF:RCo 216, 334, and 388 IU/dL; and VWFpp 156, 172, and 192 IU/dL in patients at low, intermediate, and high intensity of care, respectively. Conversely, the high‐to‐low molecular‐weight VWF multimers ratios progressively decreased with increasing intensity of care, as well as median ADAMTS13 activity levels, which ranged from 82 IU/dL for patients at low intensity of care to 62 and 55 IU/dL for those at intermediate and high intensity of care. Conclusions We found a significant alteration of the VWF‐ADAMTS13 axis in COVID‐19 patients, with an elevated VWF:Ag to ADAMTS13 activity ratio that was strongly associated with disease severity. Such an imbalance enhances the hypercoagulable state of COVID‐19 patients and their risk of microthrombosis.

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Section: Discussionsupporting

confidence: 73%

Section: Re Sultssupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The ADAMTS13‐von Willebrand factor axis in COVID‐19 patients

Mancini

Baronciani

Artoni

et al. 2021

Journal of Thrombosis and Haemostasis

197

233

View full text Add to dashboard Cite

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Hemostasis in pregnant women with COVID‐19

Ciavarella

Erra

Abbattista

et al. 2020

Intl J Gynecology & Obste

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Pregnancy is a prothrombotic condition characterized by a procoagulant imbalance that serves to protect women from bleeding but increases their risk for venous thromboembolism (VTE). 1 Coronavirus disease 2019 (COVID-19) has not spared pregnant women with regards to VTE. 2 A coagulopathy that increases the risk of thrombosis has been reported in patients with severe COVID-19 infection. 3 At present, no data are available on the hemostatic status of pregnant women with COVID-19, and whether coagulation parameters are additionally influenced by COVID-19 remains unclear.

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