Curative anticoagulation prevents endothelial lesion in COVID-19 patients

Abstract

Background: Coronavirus disease-2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders.

Objectives: To explore the coagulopathy and endothelial dysfunction in COVID-19 patients.

Methods: The study analyzed clinical and biological profiles of patients with suspected COVID-19 infection at admission, including hemostasis tests and quantification of circulating endothelial cells (CECs).

Results: Among 96 consecutive COVID-19-suspected patients fulfilling criteria for hospitalization, 66 were tested positive for SARS-CoV-2. COVID-19-positive patients were more likely to present with fever (P = .02), cough (P = .03), and pneumonia at computed tomography (CT) scan (P = .002) at admission. Prevalence of D-dimer >500 ng/mL was higher in COVID-19-positive patients (74.2% versus 43.3%; P = .007). No sign of disseminated intravascular coagulation were identified. Adding D-dimers >500 ng/mL to gender and pneumonia at CT scan in receiver operating characteristic curve analysis significantly increased area under the curve for COVID-19 diagnosis. COVID-19-positive patients had significantly more CECs at admission (P = .008) than COVID-19-negative ones. COVID-19-positive patients treated with curative anticoagulant prior to admission had fewer CECs (P = .02) than those without. Interestingly, patients treated with curative anticoagulation and angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers had even fewer CECs (P = .007).

Conclusion: Curative anticoagulation could prevent COVID-19-associated coagulopathy and endothelial lesion.

Keywords: COVID-19; D-dimers; SARS-CoV-2; circulating endothelial cells; coagulopathy.

Figure 1

Potential exclusion criteria for COVID‐19 diagnosis. The receiver operating characteristic (ROC) curve including gender and pneumonia with (red line) or without D‐dimers threshold at 500 ng/mL (blue line). ROC curve analysis identified the association of female gender, absence of pneumonia at computed tomography scan, and D‐dimers below or equal 500 ng/mL as potential exclusion criteria for COVID‐19 diagnosis (area under the curve 81.9% (95% IC 68.7%‐95.1%)

Figure 2

Effect of curative anticoagulation on circulating endothelial cell (CEC) levels in COVID‐19. Quantification of CECs in COVID‐19‐positive patients at admission. CEC level according to presence or the absence of curative anticoagulation and/or the presence or the absence of angiotensin‐converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). Red dotted line shows the upper limit of reference values for CECs (<10 CECs per mL)

Figure 3

Curative anticoagulant treatment could be part of COVID‐19 management in order to limit associated endothelial dysfunction