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Sci Rep ; 11(1): 16290, 2021 08 11.
Article in English | MEDLINE | ID: covidwho-1354111


To reveal if coagulopathies relate to the course of COVID-19, we examined 255 patients with moderate and severe COVID-19, receiving anticoagulants and immunosuppressive drugs. Coagulopathy manifested predominantly as hypercoagulability that correlated directly with systemic inflammation, disease severity, comorbidities, and mortality risk. The prolonged clotting tests in about » of cases were associated with high levels of C-reactive protein and antiphospholipid antibodies, which impeded coagulation in vitro. Contraction of blood clots was hindered in about ½ of patients, especially in severe and fatal cases, and correlated directly with prothrombotic parameters. A decrease in platelet contractility was due to moderate thrombocytopenia in combination with platelet dysfunction. Clots with impaired contraction were porous, had a low content of compressed polyhedral erythrocytes (polyhedrocytes) and an even distribution of fibrin, suggesting that the uncompacted intravital clots are more obstructive but patients could also be prone to bleeding. The absence of consumption coagulopathy suggests the predominance of local and/or regional microthrombosis rather than disseminated intravascular coagulation. The results obtained (i) confirm the importance of hemostatic disorders in COVID-19 and their relation to systemic inflammation; (ii) justify monitoring of hemostasis, including the kinetics of blood clot contraction; (iii) substantiate the active prophylaxis of thrombotic complications in COVID-19.

Blood Coagulation Disorders/etiology , Blood Platelet Disorders/etiology , COVID-19/complications , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Blood Coagulation Disorders/drug therapy , Blood Platelets/ultrastructure , COVID-19/drug therapy , Female , Humans , Inflammation/etiology , Male , Middle Aged , Patient Acuity , Thrombocytopenia/etiology , Treatment Outcome , Young Adult
Platelets ; 31(5): 627-632, 2020 Jul 03.
Article in English | MEDLINE | ID: covidwho-245402


Coronavirus disease 2019 (COVID-19) is a new infectious disease that currently lacks standardized and established laboratory markers to evaluate its severity. In COVID-19 patients, the number of platelets (PLTs) and dynamic changes of PLT-related parameters are currently a concern. The present paper discusses the potential link between PLT parameters and COVID-19. Several studies have identified a link between severe COVID-19 patients and specific coagulation index, in particular, high D-dimer level, prolonged prothrombin time, and low PLT count. These alterations reflect the hypercoagulable state present in severe COVID-19 patients, which could promote microthrombosis in the lungs, as well as in other organs. Further information and more advanced hematological parameters related to PLTs are needed to better estimate this link, also considering COVID-19 patients at different disease stages and stratified in different cohorts based on preexisting co-morbidity, age, and gender. Increasing the understanding of PLT functions in COVID-19 will undoubtedly improve our knowledge on disease pathogenesis, clinical management, and therapeutic options, but could also lead to the development of more precise therapeutic strategies for COVID-19 patients.

Betacoronavirus , Blood Platelets/physiology , Coronavirus Infections/blood , Pandemics , Pneumonia, Viral/blood , Thrombophilia/etiology , Angiotensin-Converting Enzyme 2 , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Biomarkers/blood , Blood Platelets/ultrastructure , COVID-19 , Cell Adhesion Molecules/metabolism , Coronavirus Infections/complications , Coronavirus Infections/pathology , Cytokines/metabolism , Disseminated Intravascular Coagulation/etiology , Drug Interactions , Endothelial Cells/pathology , Endothelium, Vascular/pathology , Fibrin Fibrinogen Degradation Products/analysis , Humans , Inflammation , Lung/pathology , Peptidyl-Dipeptidase A/physiology , Platelet Count , Platelet Function Tests , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Prothrombin Time , Receptors, Virus/physiology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/prevention & control , SARS-CoV-2 , Severe Acute Respiratory Syndrome/blood , Severe Acute Respiratory Syndrome/pathology , Thrombophilia/blood , Thrombophilia/drug therapy , Venous Thrombosis/epidemiology , Venous Thrombosis/etiology , Venous Thrombosis/pathology , Venous Thrombosis/prevention & control