ABSTRACT
Background: Coronavirus disease-2019 (COVID-19) increases the risk of acute ischemic stroke (AIS). Hemostasis alterations and outcomes of reperfusion therapy (thrombolysis or thrombectomy) in COVID-19- positive AIS patients are not well studied, as yet. (Figure Presented) Aims: We aimed to test hemostasis alterations in COVID-19- positive AIS patients receiving intravenous (i.v.) thrombolysis as compared to non-infected AIS patients and to correlate results with therapy outcomes and safety. Method(s): In this prospective observational study, 110 AIS patients receiving i.v. thrombolysis (recombinant tissue plasminogen activator) with/without thrombectomy were enrolled (April 2020-December 2021). Blood samples were taken on admission (within 4.5h of symptom onset), at 1h and 24h post-event. SARS-CoV- 2 RT-PCR test performed on admission confirmed acute infection in 9 cases (COVID-19+ group). Anti-SARS- CoV- 2 antibody test proved convalescence and/or vaccination in 48 patients (post-COVID/ post-vaccination group). Markers of inflammation (CRP, ferritin, IL-6), D-dimer, fibrinogen, von Willebrand factor (VWF) antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, thrombin generation, ROTEM and angiotensin convertase enzyme (ACE)1, ACE2 activities were analyzed. Stroke severity was determined by NIHSS. Therapy-associated intracerebral hemorrhage was classified according to ECASSII criteria. Short-and long-term outcomes were defined at 7 days and 3 months post-event according to the change in NIHSS and the modified Rankin Scale, respectively. Result(s): Stroke severity was significantly greater in the COVID-19+ group. VWF antigen levels were markedly elevated in the COVID-19+ group as compared to non-infected and post-COVID/ post-vaccination groups (323 +/- 72% vs. 248 +/- 75% and 222 +/- 80%, respectively, p = 0.006). FVIII levels were parallel to VWF levels and showed significant elevation in the COVID-19+ group. Short-term outcomes of therapy and the occurrence of hemorrhagic transformation did not differ between groups. Conclusion(s): Elevated FVIII and VWF levels in COVID-19- associated AIS seem to be linked to endothelial cell injury and are associated with more severe stroke. Efficacy of thrombolysis in COVID-19+ AIS patients was similar to non-infected patients in this cohort.
ABSTRACT
Background: Coronavirus disease-19 (COVID-19) is associated with disturbed hemostasis balance. Little is known about COVID-19- associated hemostasis alterations in pregnancy and their associations with the clinical course. Aim(s): We aimed to test hemostasis alterations in COVID-19- positive pregnant women as compared to non-infected pregnancies and to correlate results with maternal and perinatal outcomes. Method(s): In this single-center observational case-control study, 80 women with acute COVID-19 infection at 24-40 gestational weeks (COVID-19+ group) and 80 healthy age-and gestational week-matched pregnant women (COVID-19- group) were enrolled. All women were outpatients with mild/no symptoms at admission. Acute infection was confirmed/ruled out using SARS-CoV- 2 RT-PCR and/or antigen test. Blood taken on admission was analyzed for markers of inflammation (CRP, ferritin, IL-6), D-dimer, fibrinogen, von Willebrand factor antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, thrombin generation, ACE1, ACE2 activity, and anti-SARS- CoV- 2 antibody levels. Detailed clinical parameters of pregnancy, labor and post-partum period were registered. Pregnancies were followed for 6 weeks after childbirth. Result(s): In the COVID-19+ group, APTT was significantly prolonged, while PT, fibrinogen, and D-dimer levels did not significantly differ from the non-infected group. FVIII activity was significantly lower in the COVID-19+ group as compared to COVID-19- group (183.7 +/- 55.9% vs. 201.7 +/- 49.2%, p = 0.03). Similarly, FXIII activity was significantly reduced in COVID-19+ pregnant women (80.6 +/- 23.5% vs. COVID-19- group: 91.6 +/- 22.5%, p = 0.04). Pregnancy-associated complications were observed in 5 COVID-19+ cases, with marked alterations of coagulation screening tests, clot-lysis assay, and increased D-dimer. Perinatal complications were observed in 6 cases and one newborn tested positive for SARS-CoV- 2. Two cases of severe post-partum hemorrhage were observed in the COVID-19+ group. No post-partum thrombotic events occurred. Conclusion(s): In this cohort, third-trimester COVID-19+ pregnancies were associated with reduced levels of FVIII and FXIII activity. In a few cases, marked alterations of hemostasis and fibrinolysis balance occurred, which were accompanied by pregnancy complications.
ABSTRACT
The new coronavirus infection (COVID-19) is associated with significant changes in hemostasis parameters, however, little is known about COVID-19-associated coagulopathy in pregnancy. In this observational case-control study, 39 women with acute COVID-19 infection at 36-40 gestational weeks of their pregnancy (COVID-19+ group) and 21 healthy age-and gestational week-matched pregnant women were enrolled (COVID-19-group). All women were outpatients and acute infection was confirmed or ruled out using SARS-CoV-2 RT-PCR or antigen test. In addition to screening tests of coagulation, D-dimer, fibrinogen, von Willebrand factor antigen, chromogenic factor VIII (FVIII) activity, factor XIII (FXIII) activity, in vitro clot-lysis, angiotensin convertase enzyme (ACE) activity, and anti-SARS-CoV-2 antibody levels were measured. In the COVID-19+ group, APTT was significantly increased, while PT, TT, fibrinogen and D-dimer were not significantly different as compared to the COVID-19-group. FVIII activity was significantly lower in the COVID-19+ group (183.7±47.7%) as compared to COVID-19-group (226.7±62.5%, p=0.01). Similarly, FXIII activity was reduced in the COVID-19+ group (82.3±23.5% vs. COVID-19-group: 96.2±26.6%, p=0.04). Pregnancy-associated complications including HELLP syndrome were observed in 2 cases of COVID-19+ group, with marked alterations of coagulation screening tests, clot-lysis and D-dimer levels. Conclusion: Pregnancy associated with SARS-CoV-2 infection in the third trimester leads to reduced levels of FVIII and FXIII activity, most likely as a result of increased coagulation activation and consumption.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has been associated with profound hemostasis changes and a high risk of venous thrombotic events. Little is known about hemostasis alterations in COVID-19-associated acute ischemic stroke (AIS). In this prospective observational study, blood samples of 69 AIS patients, all receiving intravenous recombinant tissue plasminogen activator, were taken on admission. SARS-CoV-2 RT-PCR test was performed in all patients and acute infection was confirmed in 8 cases (COVID-19+ group). Convalescence or vaccination was proven by an anti-SARS-CoV-2 antibody test in 5 patients (post-COVID/post-vaccination group). Screening tests of coagulation, D-dimer, fibrinogen, von Willebrand factor (VWF) antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, ACE activity and ROTEM analysis were performed from the blood samples. Stroke severity was determined by NIHSS. Short-and long-term outcomes were defined at 7 and 90 days post-event by ΔNIHSS and the modified Rankin Scale. Stroke severity was significantly greater in the COVID-19+ group. VWF antigen levels were markedly elevated in the COVID-19+ group as compared to non-infected and post-COVID/post-vaccination groups (329±94 vs. 244±75 and 210±66%, respectively, p=0.027). FVIII levels were parallel to VWF levels and showed significant elevation in the COVID-19+ group. Short-term outcomes of therapy did not differ between groups. Conclusion: Elevated FVIII and VWF levels in COVID-19-associated AIS seem to be linked to endothelial cell injury and are associated with more severe stroke.