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Non-severe COVID-19 is associated with endothelial damage and hypercoagulability despite pharmacological

Sarah Kelliher1,2, Luisa Weiss2,3, Sarah Cullivan2,4

  • 1Department of Haematology, Mater Misericordiae University Hospital, Dublin, Ireland.

Journal of Thrombosis and Haemostasis : JTH
|February 1, 2022
PubMed

Insights

Moderate COVID-19 patients show increased blood clotting and endothelial damage despite standard heparin treatment. This hypercoagulability persists, suggesting potential benefits of higher heparin doses in managing COVID-19 complications.

Area of Science:

  • Cardiology
  • Hematology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is characterized by hypercoagulability and endothelial dysfunction, which predict disease severity.
  • A high incidence of thrombosis occurs in moderate to severe COVID-19 cases, even with thromboprophylaxis.
  • Therapeutic-intensity heparin may improve survival in moderate COVID-19 by stabilizing the endothelium and reducing inflammation.

Purpose of the Study:

  • To investigate if moderate COVID-19 patients exhibit enhanced hypercoagulability compared to non-COVID-19 hospitalized patients, despite standard low molecular weight heparin (LMWH) thromboprophylaxis.
  • To assess markers of endothelial damage and plasma thrombin generation in COVID-19 patients receiving LMWH.
  • To compare these markers between COVID-19 patients and a control group of SARS-CoV-2-negative hospitalized patients.

Main Methods:

  • Recruitment of moderate COVID-19 patients and a control group of SARS-CoV-2-negative hospitalized patients.
  • Administration of low molecular weight heparin (LMWH) thromboprophylaxis to both groups.
  • Assessment of endothelial damage markers and plasma thrombin generation parameters.

Main Results:

  • Tissue plasminogen activator levels were significantly higher in the COVID-19 group.
  • Endogenous thrombin potential was significantly increased in COVID-19 patients despite thromboprophylaxis.
  • Lag time to thrombin generation was prolonged in COVID-19 patients, an effect abrogated by an anti-TFPI antibody.

Conclusions:

  • Moderate COVID-19 is linked to increased plasma thrombin generation and endothelial damage.
  • Hypercoagulability persists in COVID-19 patients even with standard LMWH thromboprophylaxis.
  • Findings support further investigation into escalated heparin dosing for non-severe COVID-19 to improve outcomes.
Abstract

Keywords:
COVID-19endotheliumheparinthrombosisvenous thromboembolism

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