Circulating Levels of Tissue Plasminogen Activator and Plasminogen Activator Inhibitor-1 Are Independent Predictors of Coronavirus Disease 2019 Severity: A Prospective, Observational Study

A substantial pool of evidence suggests that the pathophysi-ologyof the severeform ofcoronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state termed COVID-19-associated coagulopathy (CAC), 1 – 3 and character-ized by micro- and macrovascular thrombosis. 4,5 Approximately 27% of critically ill intensive care unit (ICU)-admitted COVID-19 patients develop venous thromboembolism during admission, peak

[1]  P. Morange,et al.  Production of Plasminogen Activator Inhibitor 1 by Human Adipose Tissue: Possible Link Between Visceral Fat Accumulation and Vascular Disease , 1997, Diabetes.

[2]  M. Matthay,et al.  Insufficient hyperfibrinolysis in COVID-19: a systematic review of thrombolysis based on meta-analysis and meta-regression , 2020, medRxiv.

[3]  F. Violi,et al.  Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge , 2020, Thrombosis and Haemostasis.

[4]  G. Grasselli,et al.  Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis , 2020, Journal of Thrombosis and Haemostasis.

[5]  C. Bouchard,et al.  Regular Exercise, Plasminogen Activator Inhibitor-1 (PAI-1) Activity and the 4G/5G Promoter Polymorphism in the PAI-1 Gene , 1999, Thrombosis and Haemostasis.

[6]  Axel Haverich,et al.  Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. , 2020, The New England journal of medicine.

[7]  D. Sugarbaker,et al.  Developmental expression of plasminogen activator inhibitor type 1 by human alveolar macrophages. Possible role in lung injury. , 1990, Journal of immunology.

[8]  R. McIntyre,et al.  Tissue plasminogen activator (tPA) treatment for COVID‐19 associated acute respiratory distress syndrome (ARDS): A case series , 2020, Journal of Thrombosis and Haemostasis.

[9]  G. Lippi,et al.  D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis , 2020, Thrombosis and Haemostasis.

[10]  A. Zangrillo,et al.  Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis , 2020, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[11]  R. McIntyre,et al.  Fibrinolysis Shutdown Correlation with Thromboembolic Events in Severe COVID-19 Infection , 2020, Journal of the American College of Surgeons.

[12]  T. Martin,et al.  Local abnormalities in coagulation and fibrinolytic pathways predispose to alveolar fibrin deposition in the adult respiratory distress syndrome. , 1989, The Journal of clinical investigation.

[13]  P. Myles,et al.  Fibrinolysis and COVID‐19: A plasmin paradox , 2020, Journal of Thrombosis and Haemostasis.

[14]  O. Olivieri,et al.  A relative ADAMTS13 deficiency supports the presence of a secondary microangiopathy in COVID 19 , 2020, Thrombosis Research.

[15]  J. George,et al.  Plasminogen activator inhibitor (PAI‐1) antigen levels in primary TTP and secondary TTP post‐bone marrow transplantation , 1998, American journal of hematology.

[16]  D. Talmor,et al.  Salvage use of tissue plasminogen activator (tPA) in the setting of acute respiratory distress syndrome (ARDS) due to COVID-19 in the USA: a Markov decision analysis , 2020, World Journal of Emergency Surgery.

[17]  D. Gommers,et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19 , 2020, Thrombosis Research.

[18]  T. van der Poll,et al.  Plasminogen activator and plasminogen activator inhibitor I release during experimental endotoxaemia in chimpanzees: effect of interventions in the cytokine and coagulation cascades. , 1995, Clinical science.

[19]  L. Adams,et al.  Plasminogen activator inhibitor type‐1 and interleukin‐6 in haemolytic uraemic syndrome , 2000, Journal of paediatrics and child health.

[20]  L. Argaud,et al.  Hypofibrinolytic state and high thrombin generation may play a major role in SARS‐COV2 associated thrombosis , 2020, Journal of Thrombosis and Haemostasis.

[21]  G. Lippi,et al.  Circulating Plasminogen Concentration at Admission in Patients with Coronavirus Disease 2019 (COVID-19) , 2020, Seminars in Thrombosis and Hemostasis.

[22]  R. Becker COVID-19 update: Covid-19-associated coagulopathy , 2020, Journal of Thrombosis and Thrombolysis.

[23]  Andrea Gianatti,et al.  Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study , 2020, The Lancet Infectious Diseases.

[24]  R. Rumbaut,et al.  Microvascular thrombosis: experimental and clinical implications , 2020, Translational Research.

[25]  I. Cheruiyot,et al.  Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review , 2020, Annals of Vascular Surgery.

[26]  Giuseppe Lippi,et al.  Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis , 2020, Clinica Chimica Acta.

[27]  C. Maas,et al.  Amplified endogenous plasmin activity resolves acute thrombotic thrombocytopenic purpura in mice , 2017, Journal of thrombosis and haemostasis : JTH.

[28]  I. Jaunalksne,et al.  Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: A Prospective Pilot Study , 2016, Front. Med..