Hemato (Jan 2022)

Persisting Endothelial Cell Activation and Hypercoagulability after COVID-19 Recovery—The Prospective Observational ROADMAP-Post COVID-19 Study

  • Grigorios T. Gerotziafas,
  • Patrick Van Dreden,
  • Theodoros N. Sergentanis,
  • Marianna Politou,
  • Aurélie Rousseau,
  • Matthieu Grusse,
  • Michèle Sabbah,
  • Ismail Elalamy,
  • Vasiliki Pappa,
  • Tina Skourti,
  • Tina Bagratuni,
  • Ioannis Ntanasis-Stathopoulos,
  • Eleni Korompoki,
  • Stavroula Labropoulou,
  • Meletios A. Dimopoulos,
  • Evangelos Terpos

DOI
https://doi.org/10.3390/hemato3010010
Journal volume & issue
Vol. 3, no. 1
pp. 111 – 121

Abstract

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Background. Hypercoagulable state and endothelial cell activation are common alterations in patients with COVID-19. Nevertheless, the hypothesis of persistent hypercoagulability and endothelial cell activation following recovery from COVID-19 remains an unresolved issue. Objectives. To investigate the persistence of endothelial cell activation and hypercoagulability after recovery from COVID-19. Patients/Methods. COVID-19 survivors (n = 208) and 30 healthy individuals were enrolled in this study. The following biomarkers were measured: procoagulant phospholipid-dependent clotting time (PPL-ct), D-Dimer, fibrin monomers (FM), free Tissue factor pathway inhibitor (free-TFP)I, heparinase, and soluble thrombomodulin (sTM). Antibodies against SARS-CoV-2 (IgG and IgA) were also measured. Results. The median interval between symptom onset and screening for SARS-CoV-2 antibodies was 62 days (IQR = 22 days). Survivors showed significantly higher levels of D-Dimers, FM, TFPI, and heparanase as compared to that of the control group. Survivors had significantly shorter PPL-ct. Elevated D-dimer was associated with older age. Elevated FM was associated with female gender. Elevated heparanase was independently associated with male gender. Decreased Procoag-PPL clotting time was associated with female gender. One out of four of COVID-19 survivors showed increase at least one biomarker of endothelial cell activation or hypercoagulability. Conclusions. Two months after onset of COVID-19, a significant activation of endothelial cells and in vivo thrombin generation persists in at least one out of four survivors of COVID-19. The clinical relevance of these biomarkers in the diagnosis and follow-up of patients with long COVID-19 merits to be evaluated in a prospective clinical study.

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