Efficiency of anticoagulant protein c system in patients with coronavirus infection caused by the SARS-COV-2

ABSTRACT

Background: The concept of immunothrombosis has established as a central pathogenic factor leading to thrombosis complications, respiratory failure, and a multiple organ failure in patents with COVID-19. Studying of the hypercoagulability in patients with COVID-19 could be useful for improving of disease's outcomes. Estimation of anticoagulants efficiency can be informative for thrombotic risk assessment. The highest interest presents protein C system, because, as we know, infection and inflammation lead to disfunction of this anticoagulant system. Aims: To estimate the efficiency of protein C anticoagulant system in COVID-19 patients. Methods: The study included 60 patients with COVID-19 and 21 healthy controls . Thrombin generation was assessed by CAT according to Hemker et al. Measure was conducted in platelet poor plasma with or without presence of thrombomodulin. The following parameters were determined endogenous thrombin potential (ETP, nM∗min), peak thrombin (Peak, nM). Sensitivity ETP and Peak for thrombomodulin were calculated as percent of decreasing of these parameters after adding thrombomodulin to the assay. Reduction of sensitivity for thrombomodulin indicates dysfunction of anticoagulant protein C system. Protein C activity and free protein S level were measured by 'ACL ELIT PRO', Instrumentation Laboratory, USA. STATISTICA 12.0 package was used. Results are presented as median with 95% confidence intervals, P < 0.05 was considered statistically significant (∗). Results: Sensitivity ETP and Peak for thrombomodulin, protein C activity and free protein S level are presented in the table. Conclusions: The efficiency of protein C anticoagulant system is depressed in COVID-19 patients. It may be associate with protein S level decreasing. The disability of anticoagulant protein C system can lead to hypercoagulability and it may be cause of thrombotic complication.