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Plasma tissue plasminogen activator and plasminogen activator inhibitor-1 in hospitalized COVID-19 patients

Yu Zuo1, Mark Warnock2, Alyssa Harbaugh1

  • 1Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.

Scientific Reports
|January 16, 2021
PubMed

Insights

COVID-19 patients show elevated tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). Extremely high tPA levels enhance clot lysis and correlate with mortality, indicating complex fibrinolysis in severe COVID-19.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus disease-19 (COVID-19) patients exhibit high risks for thrombotic events and bleeding complications.
  • Understanding the coagulation and fibrinolysis balance is crucial for managing COVID-19-associated thrombosis and exploring fibrinolytic therapies.

Purpose of the Study:

  • To investigate the levels and implications of tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in hospitalized COVID-19 patients.
  • To explore the relationship between these fibrinolytic factors, neutrophil activation, respiratory status, and patient outcomes, including mortality.

Main Methods:

  • Plasma levels of tPA and PAI-1 were measured in 118 hospitalized COVID-19 patients and 30 healthy controls.
  • Spontaneous clot-lysis assays were performed.
  • Correlations with neutrophil counts, activation markers, respiratory status, and mortality were analyzed.

Main Results:

  • COVID-19 patients displayed significantly elevated tPA and PAI-1 levels, correlating with neutrophil activation.
  • High tPA and PAI-1 levels were associated with poorer respiratory status.
  • Elevated tPA, specifically, correlated strongly with mortality and enhanced spontaneous clot lysis.

Conclusions:

  • Fibrinolytic homeostasis in COVID-19 is complex, with some patients exhibiting a pro-fibrinolytic state.
  • Extremely high tPA levels may enhance fibrinolysis and are linked to increased mortality in a subset of COVID-19 patients.
  • Tissue-type plasminogen activator (tPA) warrants further investigation as a potential prognostic biomarker in COVID-19.

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