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Updated: Jun 29, 2025
Comprehensive Analysis of Procoagulant Platelets Exhibiting Features of Necrosis, Apoptosis and Platelet Activation
Published on: May 23, 2025
Association between loss of hypercoagulable phenotype, clinical features and complement pathway consumption in
Daisuke Kasugai1, Taku Tanaka1, Takako Suzuki2
1Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
In severe COVID-19, a hypercoagulable state correlates with better outcomes, while a normocoagulable state indicates poor prognosis. Understanding these coagulation dynamics is crucial for managing patients with respiratory illness.
Area of Science:
- Hematology
- Critical Care Medicine
- Immunology
Background:
- Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state.
- The effectiveness of anticoagulation therapy varies with COVID-19 severity.
- Coagulation profile dynamics and their link to disease severity and outcomes require further investigation.
Purpose of the Study:
- To evaluate the dynamics of coagulation profiles in patients with COVID-19 requiring respiratory support.
- To assess the association between coagulation status and COVID-19 severity, patient outcomes, and biomarker trajectories.
- To characterize the coagulation phenotype in relation to disease severity and recovery.
Main Methods:
- A multicenter, prospective, observational study of 166 COVID-19 patients needing respiratory support.
- Rotational thromboelastometry was used to assess coagulation and fibrinolysis.
- Longitudinal laboratory parameters were collected to define the coagulation phenotype.
Main Results:
- Severely ill patients exhibited higher maximum clot elasticity and lower maximum lysis compared to those on non-invasive oxygen.
- A hypercoagulable phenotype was linked to faster recovery in severely ill patients (15 days vs. 27 days).
- In severe COVID-19, a normocoagulable phenotype correlated with complement alternative pathway activation and poorer outcomes.
Conclusions:
- Hypercoagulable states intensify with increasing COVID-19 respiratory disease severity.
- A normocoagulable phenotype in severe COVID-19 is associated with alternative complement pathway activation and adverse outcomes.
- Coagulation marker dynamics are interconnected with complement system activation and alveolar injury markers.
Background:
Coronavirus disease 2019 (COVID-19) features a hypercoagulable state, but therapeutic anticoagulation effectiveness varies with disease severity. We aimed to evaluate the dynamics of the coagulation profile and its association with COVID-19 severity, outcomes, and biomarker trajectories.
Methods:
This multicenter, prospective, observational study included patients with COVID-19 requiring respiratory support. Rotational thromboelastometry findings were evaluated for coagulation and fibrinolysis status. Hypercoagulable status was defined as supranormal range of maximum clot elasticity in an external pathway. Longitudinal laboratory parameters were collected to characterize the coagulation phenotype.
Results:
Of 166 patients, 90 (54%) were severely ill at inclusion (invasive mechanical ventilation, 84; extracorporeal membrane oxygenation, 6). Higher maximum elasticity (P=0.02) and lower maximum lysis in the external pathway (P=0.03) were observed in severely ill patients compared with the corresponding values in patients on non-invasive oxygen supplementation. Hypercoagulability components correlated with platelet and fibrinogen levels. Hypercoagulable phenotype was associated with favorable outcomes in severely ill patients, while normocoagulable phenotype was not (median time to recovery, 15 days vs. 27 days, P=0.002), but no significant association was observed in moderately ill patients. In patients with severe COVID-19, lower initial C3, minimum C3, CH50, and greater changes in CH50 were associated with the normocoagulable phenotype. Changes in complement components correlated with dynamics of coagulation markers, hematocrit, and alveolar injury markers.
Conclusions:
While hypercoagulable states become more evident with increasing severity of respiratory disease in patients with COVID-19, normocoagulable phenotype is associated with triggered by alternative pathway activation and poor outcomes.
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