Cellular and molecular mechanisms in COVID-19 coagulopathy: role of inflammation and endotheliopathy

Introduction Coronavirus 2 (CoV-2) infection or coronavirus disease 2019 (COVID-19) is frequently associated with microvascular thrombosis.The microthrombosis in COVID-19 is the result of the interplay between inflammation and endotheliopathy. Elevated interleukin-6 (IL-6) characterizes COVID-19 inflammation resulting in endotheliopathy and coagulopathy marked by elevated D-dimer (DD). Aim of this study is to identify and to describe the coagulation changes in 100 moderate COVID-19 patients having lung involvement and to determine the association of coagulopathy with the severity and prognosis. Methods Inflammation, endothelial and coagulation molecules were measured in moderate and mild disease. Results IL-6 and tumor necrosis factor-alpha (TNF-alpha) and tissue factor (TF), von Willebrand factor (VWF), and tissue factor pathway inhibitor (TFPI) significantly increased in moderate disease as well as D-dimer, thrombin antithrombin complex (TAT), Fibrinogen (Fib), platelet factor-4 (PF4), beta-thromboglobulin (beta-TG), P-selectin, and platelet adhesion. Shortened clotting time (CT) and clot formation time (CFT), high maximum clot firmness (MCF) and low LY at 30 min were present in 100% of moderate COVID-19 patients compared with mild COVID-19 patients. Conclusions These findings demonstrate that moderate COVID-19 has a profound inflammation associated with severee ndotheliopathy and intense coagulation activation uncontrolled by TFPI. Attention should be paid to coagulopathy in COVID-19. Closely monitoring of coagulation and application of appropriate anticoagulation may improve the prognosis of moderate COVID-19 and to prevent the progression to severe COVID-19 disease.

Automated summary

The study found that moderate COVID-19 patients have significantly elevated levels of inflammation, endothelial and coagulation molecules, indicating severe abnormalities in coagulation function. Compared to mild patients, moderate COVID-19 patients have significantly shortened clotting time, decreased clot formation time, and enhanced clotting activity. Therefore, attention should be paid to coagulopathy in COVID-19, closely monitoring coagulation status and appropriately applying anticoagulants may help improve the prognosis of moderate patients and prevent disease progression.