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Thromb Haemost 2021; 121(08): 1087-1096
DOI: 10.1055/s-0041-1722919
Cellular Haemostasis and Platelets

Assessment of Platelet Thrombus Formation under Flow Conditions in Adult Patients with COVID-19: An Observational Study

Stefano Ghirardello
1   Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Anna Lecchi
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Andrea Artoni‡   *
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Mauro Panigada‡   *
3   Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
,
Stefano Aliberti
4   Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
5   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Erica Scalambrino
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Silvia La Marca
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Marco Boscarino
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Andrea Gramegna
4   Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Paolo Properzi
3   Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
,
Chiara Abruzzese
3   Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
,
Francesco Blasi
4   Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
5   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Giacomo Grasselli
3   Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
5   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Fabio Mosca
1   Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
6   Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
,
Armando Tripodi
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Flora Peyvandi
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
5   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
› Author Affiliations Funding This work was (partially) supported by the Italian Ministry of Health - Bando Ricerca Corrente.
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Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation, which may dysregulate platelet function. Total Thrombus-Formation Analysis System (T-TAS) is a flow-chamber device that analyses platelet-mediated thrombus formation in capillary channels through the following parameters: (1) the area under the flow-pressure curve (AUC), (2) occlusion start time (OST), time needed to reach OST, and (3) occlusion time (OT), time needed to reach the occlusion pressure.

Methods and Findings Sixty-one COVID-19 patients admitted to intensive, subintensive, and low intensive care were prospectively enrolled according to the time of admission: group A (up to 8 days) (n = 18); group B (from 9 to 21 days) (n = 19), and group C ( > 21 days) (n = 24). T-TAS measurements were performed at enrolment and after 7 days. Median OST was similar among groups. AUC was lower in group A compared to B (p = 0.001) and C (p = 0.033). OT was longer in group A compared to B (p = 0.001) and C (p = 0.028). Platelet count (PC) was higher in group B compared to A (p = 0.024). The linear regression showed that OT and AUC were independent from PC in group A (OT: 0.149 [95% confidence interval [CI]: –0.326 to 0.624], p = 0.513 and AUC: 0.005 [95% CI: –0.008 to 0.017], p = 0,447). In contrast, in group B, PC was associated with OT (–0.019 [–0.028 to 0.008], p = 0.023) and AUC (0.749 [0.358–1.139], p = 0,015), similarly to group C. Conversely, patients with different illness severity had similar T-TAS parameters.

Conclusion COVID-19 patients display an impaired platelet thrombus formation in the early phase of the disease compared to later stages and controls, independently from illness severity.

Keywords

platelets - platelet function - antiplatelet therapy - arterial thrombosis - blood coagulation - T-TAS - venous thromboembolism

Authors' Contributions

S.G. conceptualized and designed the study, contributed to data analysis, interpretation, and drafted the article. A.L. contributed substantially to data acquisition, analysis, interpretation, and revised it critically for important intellectual content. A.A. and M.P. contributed to analysis, interpretation, and critically revised the manuscript for important intellectual content. S.A., E.S., M.B., and S.L.M. contributed substantially to data acquisition, analysis, and interpretation of data. A.G., P.P., and C.A. contributed to the analysis and interpretation of data. F.B., G.G., F.M., A.T., and F.P. contributed to the conception and design of the study, data interpretation, and revised the article for important intellectual content. All authors gave final approval of the version to be submitted and any revised version.


* Andrea Artoni and Mauro Panigada contributed equally.


Supplementary Material



Publication History

Received: 25 August 2020

Accepted: 03 December 2020

Article published online:
05 February 2021

© 2021. Thieme. All rights reserved.

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