The temporal changes of hemostatic activity in hospitalized patients with COVID-19: a prospective observational study.

ABSTRACT

INTRODUCTION: Hemostatic abnormalities play an important role in the pathogenesis of COVID-19 and are considered to be determinants of patients` outcomes. Less is known about the dynamics of these abnormalities in a short-term observation. PATIENTS AND METHODS: This was a prospective observational study enrolling adult patients hospitalized due to COVID-19 in a tertiary centre in Poland from January to May 2021. Blood samples were drawn upon admission and 28 days after admission to measure markers of coagulation, fibrinolysis and endothelial dysfunction and to evaluate whether there are significant differences between these two time points. All analyses were performed in the entire cohort and after stratification into three groups depending on the degree of respiratory support. RESULTS: We recruited 245 patients at the median age of 63 years (IQR 52; 69), among whom 158 (64.5%) were males. Analysis of hemostatic markers on admission revealed hypercoagulability, hypofibrinolysis and endothelial dysfunction are related to degree of respiratory support. We found significant differences between the admission and 28-day follow-up in all markers except for plasminogen activity (123.75 vs. 121.60, p=0.938). Interestingly, markers of endothelial dysfunction remained the highest in the advanced respiratory support group after 28 days, while differences in other markers subsided. CONCLUSION: Hemostatic abnormalities are significantly attenuated within a month after hospital admission due to COVID-19. Initially observed association between severity of disease and hemostatic derangements persists only for markers of endotheliopathy.