Severe SARS-CoV-2 Infection Inhibits Fibrinolysis Leading to Changes in Viscoelastic Properties of Blood Clot: A Descriptive Study of Fibrinolysis in COVID-19

Abstract Background  Accumulating evidence indicates toward an association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and procoagulatory state in blood. Thromboelastographic investigations are useful point-of-care devices to assess coagulation and fibrinolysis. Ob...

Full description

Saved in:
Bibliographic Details
Published in:Thrombosis and haemostasis Vol. 121; no. 11; pp. 1417 - 1426
Main Authors: Hammer, Stefanie, Häberle, Helene, Schlensak, Christian, Bitzer, Michael, Malek, Nisar P., Handgretinger, Rupert, Lang, Peter, Hörber, Sebastian, Peter, Andreas, Martus, Peter, Mirakaj, Valbona, Gawaz, Meinrad, Geisler, Tobias, Althaus, Karina, Rosenberger, Peter, Bakchoul, Tamam
Format: Journal Article
Language:English
Published: Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01.11.2021
Subjects:
Coagulation and Fibrinolysis
COVID-19
fibrinolysis
thrombosis
blood coagulation
thromboelastography
ISSN:0340-6245, 2567-689X, 2567-689X
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background  Accumulating evidence indicates toward an association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and procoagulatory state in blood. Thromboelastographic investigations are useful point-of-care devices to assess coagulation and fibrinolysis. Objectives  We investigated the hypothesis that the procoagulatory state in COVID-19 patients is associated with impaired fibrinolysis system. Methods  Altogether, 29 COVID-19 patients admitted to normal wards or to the intensive care unit (ICU) were included in this descriptive study. Whole blood samples were investigated by thromboelastography to assess coagulation and fibrinolysis. Additionally, standard routine coagulation testing and immunoassays for factors of fibrinolysis as plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), plasminogen activity and α2-antiplasmin (A2AP) were performed. Results  A significantly increased lysis resistance and a significantly longer time of lysis after adding tissue plasminogen activator were observed in blood samples from ICU COVID-19 patients compared with healthy controls (maximal lysis: 3.25 ± 0.56 vs. 6.20 ± 0.89%, p  = 0.0127; lysis time: 365.7 ± 44.6 vs. 193.2 ± 16.3 seconds, p  = 0.0014). PAI-1 activity was significantly higher in plasma samples of ICU COVID-19 patients (PAI-1: 4.92 ± 0.91 vs. 1.28 ± 0.33 U/mL, p  = 0.001). A positive correlation between the activity of PAI-1 and lysis time of the formed clot ( r  = 0.70, p  = 0.0006) was observed. Conclusion  Our data suggest that severe SARS-CoV-2 infection is associated with impaired fibrinolytic activity in blood, where fibrinolytic inhibitors are elevated leading to an increased resistance to clot lysis. Thromboelastography could offer a tool to investigate the contribution of the fibrinolytic status to the procoagulatory condition in COVID-19.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ObjectType-Undefined-3
ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1055/a-1400-6034