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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay

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Marked factor V activity elevation in severe COVID-19 is associated with venous thromboembolism

Jonathan A Stefely1, Bianca B Christensen1, Tasos Gogakos1

  • 1Department of Pathology, Coagulation Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

American Journal of Hematology
|August 25, 2020
PubMed

Insights

Elevated factor V activity is a key indicator in severe COVID-19, linked to increased clotting risk and mortality. This finding suggests factor V as a potential biomarker for guiding treatment in coronavirus disease 2019 patients.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coagulopathy is a significant complication of coronavirus disease 2019 (COVID-19), contributing to patient morbidity and mortality.
  • The precise mechanisms driving COVID-19-associated coagulopathy remain incompletely understood, and effective biomarkers are limited.
  • Early clinical observations noted elevated factor V activity in COVID-19 patients.

Purpose of the Study:

  • To investigate the role and clinical significance of factor V activity in patients with severe COVID-19.
  • To compare factor V, VIII, and X activity in COVID-19 patients against control groups.
  • To identify potential biomarkers for predicting clinical outcomes in COVID-19.

Main Methods:

  • Factor V, VIII, and X activity were measured in 102 inpatients with COVID-19.
  • Control groups included contemporaneous SARS-CoV-2-negative individuals (n=17) and historical pre-pandemic cohorts (n=260-478).
  • Clinical outcomes such as ventilator use, thrombotic events (DVT/PE), and mortality were analyzed in relation to factor V activity levels.

Main Results:

  • Factor V activity was significantly elevated in COVID-19 patients (median 150 IU/dL) compared to controls (median 105 IU/dL) (P < .001).
  • Elevated factor V activity (>150 IU/dL) was associated with a higher incidence of deep vein thrombosis or pulmonary embolism (33% vs 13%, P = .03).
  • Factor V activity correlated with SARS-CoV-2 viral load in a sex-dependent manner and decreasing levels predicted progression toward disseminated intravascular coagulation and mortality.

Conclusions:

  • Severe COVID-19 is characterized by marked perturbations in factor V activity.
  • Factor V activity is a strong indicator associated with COVID-19, surpassing other coagulation parameters.
  • Elevated factor V activity may serve as a valuable biomarker for assessing thrombotic risk and guiding anticoagulation therapy in COVID-19 patients.

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