Thrombotic Events in COVID-19 Are Associated With a Lower Use of Prophylactic Anticoagulation Before Hospitalization and Followed by Decreases in Platelet Reactivity

Frontiers in Medicine

article

Chantal C. Clark¹  Naomi M. J. Parr¹  Silvie A. E. Sebastian¹  Arnold C. Koekman¹  Annet C. W. van Wesel¹  Harriet M. R. van Goor²  Roy Spijkerman³  Suzanne H. Bongers³  Erhard van der Vries¹  Stefan Nierkens³  Marianne Boes³  Bernard N. Jukema¹  Leo Koenderman³  Karin A. H. Kaasjager²  Coen Maas¹  Arjan D. Barendrecht¹  Judith S. Spanjaard³  Nikita K. N. Jorritsma³  Simone Smits¹  Steven de Maat¹  Cor W. Seinen¹  Sandra Verhoef¹ 

[1] Department of Central Diagnostic Laboratory Research, University Medical Center Utrecht, Utrecht University;Department of Internal Medicine, University Medical Center Utrecht, Utrecht University;Center for Translational Immunology, University Medical Center Utrecht, Utrecht University;Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht University;Department of Trauma Surgery, University Medical Center Utrecht, Utrecht University

关键词: COVID-19;    platelets;    SARS-CoV-2;    thrombosis;    thrombotic event;    pulmonary thrombosis;    thromboinflammation;   

DOI  :  10.3389/fmed.2021.650129

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Coronavirus disease of 2019 (COVID-19) is associated with a prothrombotic state and a high incidence of thrombotic event(s) (TE). Objectives: To study platelet reactivity in hospitalized COVID-19 patients and determine a possible association with the clinical outcomes thrombosis and all-cause mortality. Methods: Seventy nine hospitalized COVID-19 patients were enrolled in this retrospective cohort study and provided blood samples in which platelet reactivity in response to stimulation with ADP and TRAP-6 was determined using flow cytometry. Clinical outcomes included thrombotic events, and all-cause mortality. Results: The incidence of TE in this study was 28% and all-cause mortality 16%. Patients that developed a TE were younger than patients that did not develop a TE [median age of 55 vs. 70 years; adjusted odds ratio (AOR) = 0.96 per 1 year of age, 95% confidence interval (CI) 0.92–1.00; p = 0.041]. Furthermore, patients using preexisting thromboprophylaxis were less likely to develop a thrombotic complication than patients that were not (18 vs. 54%; AOR = 0.19, 95% CI 0.04–0.84; p = 0.029). Conversely, having asthma strongly increased the risk on TE development (AOR = 6.2, 95% CI 1.15–33.7; p = 0.034). No significant differences in baseline P-selectin expression or platelet reactivity were observed between the COVID-19 positive patients ( n = 79) and COVID-19 negative hospitalized control patients ( n = 21), nor between COVID-19 positive survivors or non-survivors. However, patients showed decreased platelet reactivity in response to TRAP-6 following TE development. Conclusion: We observed an association between the use of preexisting thromboprophylaxis and a decreased risk of TE during COVID-19. This suggests that these therapies are beneficial for coping with COVID-19 associated hypercoagulability. This highlights the importance of patient therapy adherence. We observed lowered platelet reactivity after the development of TE, which might be attributed to platelet desensitization during thromboinflammation.

【 授权许可】

CC BY