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Tripodi A, Rossi SC, Clerici M, et al. Pro-coagulant imbalance in patients with community acquired pneumonia assessed on admission and one month after hospital discharge. Clin Chem Lab Med. 2021;59(10):1699-1708doi: 10.1515/cclm-2021-0538.
Tripodi, A., Rossi, S. C., Clerici, M., Merati, G., Scalambrino, E., Mancini, I., Baronciani, L., Boscarino, M., Monzani, V., & Peyvandi, F. (2021). Pro-coagulant imbalance in patients with community acquired pneumonia assessed on admission and one month after hospital discharge. Clinical chemistry and laboratory medicine, 59(10), 1699-1708. https://doi.org/10.1515/cclm-2021-0538
Tripodi, Armando, et al. "Pro-coagulant imbalance in patients with community acquired pneumonia assessed on admission and one month after hospital discharge." Clinical chemistry and laboratory medicine vol. 59,10 (2021): 1699-1708. doi: https://doi.org/10.1515/cclm-2021-0538
Tripodi A, Rossi SC, Clerici M, Merati G, Scalambrino E, Mancini I, Baronciani L, Boscarino M, Monzani V, Peyvandi F. Pro-coagulant imbalance in patients with community acquired pneumonia assessed on admission and one month after hospital discharge. Clin Chem Lab Med. 2021 Jul 01;59(10):1699-1708. doi: 10.1515/cclm-2021-0538. Print 2021 Sep 27. PMID: 34192831.
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Clin Chem Lab Med. 2021 Jul 01;59(10):1699-1708. doi: 10.1515/cclm-2021-0538. Print 2021 Sep 27.

Pro-coagulant imbalance in patients with community acquired pneumonia assessed on admission and one month after hospital discharge.

Clinical chemistry and laboratory medicine

Armando Tripodi, Simona C Rossi, Marigrazia Clerici, Giuliana Merati, Erica Scalambrino, Ilaria Mancini, Luciano Baronciani, Marco Boscarino, Valter Monzani, Flora Peyvandi

Affiliations

  1. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan and Fondazione Luigi Villa, Milan, Italy.
  2. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Divisione Medicina Generale Alta Intensità di Cura, Milan, Italy.
  3. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.

PMID: 34192831 DOI: 10.1515/cclm-2021-0538

Abstract

OBJECTIVES: Patients hospitalized because of community-acquired-pneumonia (CAP) are at risk of cardiovascular diseases. Although plasma procoagulant imbalance play a role, mechanisms are not completely understood. We aimed to investigate whether there is a measurable state of procoagulant imbalance following inflammation determined by CAP.

METHODS: We analyzed blood from 51 CAP patients at admission and 51 healthy subjects (HS) for (i) pro and anticoagulants, (ii) thrombin generation (TG) with or without thrombomodulin (TM), which is the physiologic activator of the protein C anticoagulant pathway and(iii) by assessing the ratio between von Willebrand-factor (VWF) and its protease ADAMTS13. Thirty patients were re-analyzed one month after discharge when CAP was resolved.

RESULTS: Median levels of TG parameters, including the endogenous thrombin potential (ETP), the ETP-TM-ratio (with/without TM), peak-thrombin and velocity index were higher in patients at baseline than HS. In particular, the median (IQR) ETP-TM-ratio in patients vs. HS was 0.88 (0.83-0.91) vs. 0.63 (0.48-0.71), p<0.001. Factor (F)VIII, a potent procoagulant involved in TG was higher in patients at baseline than HS [195 U/dL (100-388) vs. 127(108-145)], p<0.001]. The ratio of VWF/ADAMTS13 was higher at baseline than HS. Cumulatively, the findings indicate a state of pro-coagulant imbalance, which (although reduced), remained high [i.e., ETP-TM-ratio, 0.80 (0.74-0.84); FVIII, 152 U/dL (122-190)] one month after discharge when the infection was resolved.

CONCLUSIONS: Patients with CAP possess a state of pro-coagulant imbalance, which remains substantially high, even when the infection is resolved. The findings suggest CAP patients as candidates for antithrombotic prophylaxis even after the resolution of infection. Clinical trials are warranted to assess the benefit/risk ratio of prophylaxis extension.

© 2021 Walter de Gruyter GmbH, Berlin/Boston.

Keywords: ADAMTS13; endothelial cells; factor VIII; respiratory infections; thrombin generation; von Willebrand factor

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