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Lipoprotein(a), venous thromboembolism and COVID-19: A pilot study.
Nurmohamed, Nick S; Collard, Didier; Reeskamp, Laurens F; Kaiser, Yannick; Kroon, Jeffrey; Tromp, Tycho R; van den Born, Bert-Jan H; Coppens, Michiel; Vlaar, Alexander P J; Beudel, Martijn; van de Beek, Diederik; van Es, Nick; Moriarty, Patrick M; Tsimikas, Sotirios; Stroes, Erik S G.
  • Nurmohamed NS; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
  • Collard D; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Reeskamp LF; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Kaiser Y; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Kroon J; Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
  • Tromp TR; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • van den Born BH; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Coppens M; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Vlaar APJ; Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Beudel M; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • van de Beek D; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • van Es N; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Moriarty PM; Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA.
  • Tsimikas S; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA.
  • Stroes ESG; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: e.s.stroes@amsterdamumc.nl.
Atherosclerosis ; 341: 43-49, 2022 01.
Article in English | MEDLINE | ID: covidwho-1719322
ABSTRACT
BACKGROUND AND

AIMS:

Thrombosis is a major driver of adverse outcome and mortality in patients with Coronavirus disease 2019 (COVID-19). Hypercoagulability may be related to the cytokine storm associated with COVID-19, which is mainly driven by interleukin (IL)-6. Plasma lipoprotein(a) [Lp(a)] levels increase following IL-6 upregulation and Lp(a) has anti-fibrinolytic properties. This study investigated whether Lp(a) elevation may contribute to the pro-thrombotic state hallmarking COVID-19 patients.

METHODS:

Lp(a), IL-6 and C-reactive protein (CRP) levels were measured in 219 hospitalized patients with COVID-19 and analyzed with linear mixed effects model. The baseline biomarkers and increases during admission were related to venous thromboembolism (VTE) incidence and clinical outcomes in a Kaplan-Meier and logistic regression analysis.

RESULTS:

Lp(a) levels increased significantly by a mean of 16.9 mg/dl in patients with COVID-19 during the first 21 days after admission. Serial Lp(a) measurements were available in 146 patients. In the top tertile of Lp(a) increase, 56.2% of COVID-19 patients experienced a VTE event compared to 18.4% in the lowest tertile (RR 3.06, 95% CI 1.61-5.81; p < 0.001). This association remained significant after adjusting for age, sex, IL-6 and CRP increase and number of measurements. Increases in IL-6 and CRP were not associated with VTE. Increase in Lp(a) was strongly correlated with increase in IL-6 (r = 0.44, 95% CI 0.30-0.56, p < 0.001).

CONCLUSIONS:

Increases in Lp(a) levels during the acute phase of COVID-19 were strongly associated with VTE incidence. The acute increase in anti-fibrinolytic Lp(a) may tilt the balance to VTE in patients hospitalized for COVID-19.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Venous Thromboembolism / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Atherosclerosis Year: 2022 Document Type: Article Affiliation country: J.atherosclerosis.2021.12.008

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Venous Thromboembolism / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Atherosclerosis Year: 2022 Document Type: Article Affiliation country: J.atherosclerosis.2021.12.008