Platelets and Antiplatelet Medication in COVID-19-Related Thrombotic Complications

Frontiers in Cardiovascular Medicine

Bernd Jilma¹  Christian Schörgenhofer¹  Marianna T. Traugott²  Erich Pawelka²  Tamara Seitz²  Mario Karolyi²  Alexander Zoufaly²  Kerstin Kammerer³  Justin Oosterlee³  Laura Brunnthaler³  Alice Assinger³  Anna Schmuckenschlager³  Waltraud C. Schrottmaier³  Anita Pirabe³  Sonja M. Treiber³  Jonas Santol⁴  David Pereyra⁴  Hubert Hackl⁵  Abdullah O. Khan⁶  Julie Rayes⁶  Matthew Pugh⁷  Stefan Heber⁸ 

[1] Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria;Department of Medicine IV, Clinic Favoriten, Vienna, Austria;Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria;Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria;Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria;Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom;Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom;Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria;

关键词: COVID-19;    infection;    platelet;    platelet dysfunction;    microthrombi;    anti-platelet therapy;   

DOI  :  10.3389/fcvm.2021.802566

来源: DOAJ

【 摘 要 】

Coronavirus disease 2019 (COVID-19) induces a hypercoagulatory state that frequently leads to thromboembolic complications. Whereas anticoagulation is associated with reduced mortality, the role of antiplatelet therapy in COVID-19 is less clear. We retrospectively analyzed the effect of anticoagulation and antiplatelet therapy in 578 hospitalized patients with COVID-19 and prospectively monitored 110 patients for circulating microthrombi and plasma markers of coagulation in the first week of admission. Moreover, we determined platelet shape change and also thrombi in postmortem lung biopsies in a subset of patients with COVID-19. We observed no association of antiplatelet therapy with COVID-19 survival. Adverse outcome in COVID-19 was associated with increased activation of the coagulation cascade, whereas circulating microthrombi did not increase in aggravated disease. This was in line with analysis of postmortem lung biopsies of patients with COVID-19, which revealed generally fibrin(ogen)-rich and platelet-low thrombi. Platelet spreading was normal in severe COVID-19 cases; however, plasma from patients with COVID-19 mediated an outcome-dependent inhibitory effect on naïve platelets. Antiplatelet medication disproportionally exacerbated this platelet impairment in plasma of patients with fatal outcome. Taken together, this study shows that unfavorable outcome in COVID-19 is associated with a profound dysregulation of the coagulation system, whereas the contribution of platelets to thrombotic complications is less clear. Adverse outcome may be associated with impaired platelet function or platelet exhaustion. In line, antiplatelet therapy was not associated with beneficial outcome.

【 授权许可】

Unknown