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Canzano P, Brambilla M, Porro B, Cosentino N, Tortorici E, Vicini S, Poggio P, Cascella A, Pengo MF, Veglia F, Fiorelli S, Bonomi A, Cavalca V, Trabattoni D, Andreini D, Omodeo Salè E, Parati G, Tremoli E, Camera M. Platelet and Endothelial Activation as Potential Mechanisms Behind the Thrombotic Complications of COVID-19 Patients. ACTA ACUST UNITED AC 2021; 6:202-218. [PMID: 33649738 PMCID: PMC7904280 DOI: 10.1016/j.jacbts.2020.12.009] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/27/2022]
Abstract
The authors hypothesized that the cytokine storm described in COVID-19 patients may lead to consistent cell-based tissue factor (TF)-mediated activation of coagulation, procoagulant microvesicles (MVs) release, and massive platelet activation. COVID-19 patients have higher levels of TF+ platelets, TF+ granulocytes, and TF+ MVs than healthy subjects and coronary artery disease patients. Plasma MV-associated thrombin generation is present in prophylactic anticoagulated patients. A sustained platelet activation in terms of P-selectin expression and platelet-leukocyte aggregate formation, and altered nitric oxide/prostacyclin synthesis are also observed. COVID-19 plasma, added to the blood of healthy subjects, induces platelet activation similar to that observed in vivo. This effect was blunted by pre-incubation with tocilizumab, aspirin, or a P2Y12 inhibitor.
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Key Words
- ADP, adenosine diphosphate
- CAD, coronary artery disease
- COVID-19
- COVID-19, coronavirus disease-2019
- CRP, C-reactive protein
- GPA, granulocyte–platelet aggregates
- HS, healthy subject
- IL, interleukin
- IL-6
- IL-6R, interleukin-6 receptor
- LMWH, low-molecular-weight heparin
- MPA, monocyte–platelet aggregates
- MV, microvesicle
- NO, nitric oxide
- NOS, nitric oxide synthase
- PGI2, prostacyclin
- PLA, platelet–leukocyte aggregates
- PS, phosphatidylserine
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- TF, tissue factor
- antiplatelet drugs
- circulating microvesicles
- platelet activation
- tissue factor
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marina Camera
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy
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