Abstract
Summary. The novel coronavirus disease (COVID‐19) caused by SARS‐CoV‐2 virus represents a danger to many human organs and systems, hemostasis is one of them. Characteristic feature of hemostasis lesion is the tendency to excessive thrombus formation and the subsequent occurrence of thrombotic complications. Coagulopathy uniqueness in novel coronavirus infection is associ‐ ated with an increased level of fibrinogen, D‐dimer and platelet hyperactivation due to a decrease in platelets number along with their increased destruction and reduced production. The review presents an analysis of publications describing the frequency, supposed reasons and pathogenesis of thrombocytopenia and thrombosis observed in COVID‐19. Direct impact of novel corona‐ virus infection on platelet function as well as on the release of biologically active factors by platelets, is considered.
References
1. Hottz E.D., Azevedo‐Quintanilha I.G., Palhinha L. et al. Platelet activation and platelet‐monocyte aggregate formation trigger tissue factor expression in patients with severe COVID‐19. Blood. 2020;136(11):1330–41. DOI: 10.1182/blood.2020007252. PMID: 32678428. 2. Makatsariya A.D., Slukhanchuk E.V., Bitsadze V.O. et al. Thrombotic storm, hemostasis disorders and thromboinflammation in COVID‐19. Obstetrics, Gynecology and Reproduction. 2021;15(5):499– 514. (In Russ.). DOI: 10.17749/2313–7347/ob.gyn.rep.2021.247. 3. IzmozherovaN.V.,PopovA.A.,TsvetkovA.I.etal.Acutemyocardial damage in new coronavirus infection (COVID‐19). Ural’skij medi cinskij zhurnal. 2021;20(5):98–104. (In Russ.). DOI: 10.52420/2071– 5943–2021–20–5–98–104. 4. Ed Rainger G., Chimen M., Harrison M.J. et al. The role of platelets in the recruitment of leukocytes during vascular disease. Platelets. 2015;26(6):507–20. DOI: 10.3109/09537104.2015.1064881. PMID: 26196409. 5. Smyth S.S., McEver R.P., Weyrich A.S. et al. Platelet functions beyond hemostasis. J Thromb Haemost. 2009;7(11):1759–66. DOI: 10.1111/j.1538–7836.2009.03586.x. PMID: 19691483. 6. Estevez B., Du X. New concepts and mechanisms of platelet activation signaling. Physiology (Bethesda). 2017;32(2):162–77. DOI: 10.1152/physiol.00020.2016. PMID: 28228483. 7. Hottz E.D., Bozza F.A., Bozza P.T. Platelets in immune response to virus and immunopathology of viral infections. Front Med (Lau sanne). 2018;5:121. DOI: 10.3389/fmed.2018.00121. PMID: 29761104. 8. Herter J.M., Rossaint J., Zarbock A. Platelets in inflammation and immunity [published correction appears in J Thromb Haemost. 2015 Mar;13(3):490]. J Thromb Haemost. 2014;12(11):1764–75. DOI: 10.1111/jth.12730. PMID: 25224706. 9. Liu Y., Sun W., Guo Y. et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020;31(4):490–6. DOI: 10.1080/09537104.2020.1754383. PMID: 32297540. 10. GuanW.J., NiZ.Y., HuY. et al. China Medical Treatment Expert Group for Covid‐19 clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20. DOI: 10.1056/ NEJMoa2002032. PMID: 32109013. 11. Yang X., Yang Q., Wang Y. et al. Thrombocytopenia and its association with mortality in patients with COVID‐19. J Thromb Hae most. 2020;18(6):1469–72. DOI: 10.1111/jth.14848. PMID: 32302435. 12. Thachil J. What do monitoring platelet counts in COVID‐19 teach us? J Thromb Haemost. 2020;(8):2071–2. DOI: 10.1111/jth.14879. PMID: 32344467. 13. Lippi G., Plebani M., Henry B.M. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID‐19) infections: A meta‐analysis. Clin Chim Acta. 2020;506:145–8. DOI: 10.1016/j. cca.2020.03.022. PMID: 32178975. 14. Henry B.M., de Oliveira M.H., Benoit S. et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID‐19): a meta‐analysis. Clin Chem Lab Med. 2020;58(7):1021– 8. DOI: 10.1515/cclm‐2020–0369. PMID: 32286245. 15. Zabolotskikh I.B., Kirov M. Yu., Lebedinskii K.M. et al. Anesthesia and intensive care for patients with COVID‐19. Russian Federation of anesthesiologists and reanimatologists guidelines. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2022;(1):5–140. (In Russ.). DOI: 10.21320/1818–474X‐2022–1–5–140. 16. Assinger A. Platelets and infection — an emerging role of platelets in viral infection. Front Immunol. 2014;5:649. DOI: 10.3389/ fimmu.2014.00649. PMID: 25566260. 17. Seyoum M., Enawgaw B., Melku M. Human blood platelets and viruses: defense mechanism and role in the removal of viral pathogens. Thromb J. 2018;16:16. DOI: 10.1186/s12959–018–0170–8. PMID: 30026673. 18. Zhang Y., Zeng X., Jiao Y. et al. Mechanisms involved in the development of thrombocytopenia in patients with COVID‐19. Thromb Res. 2020;193:110–5. DOI: 10.1016/j.thromres.2020.06.008. PMID: 32535232. 19. Amgalan A., Othman M. Exploring possible mechanisms for COVID‐19 induced thrombocytopenia: Unanswered questions. J Thromb Haemost. 2020;18(6):1514–6. DOI: 10.1111/jth.14832. PMID: 32278338. 20. Petrishchev N.N., Khalepo O.V., Vavilenkova Yu.A., Vlasov T.D. COVID‐19 and vascular disorders (literature review). Regionarnoe krovoobrashchenie i mikrocirkulyaciya. 2020;19(3):90–8. (In Russ.). DOI: 10.24884/1682–6655–2020–19–3–90–98. 21. Middeldorp S., Coppens M., van HaapsT.F. Incidence of venous thromboembolism in hospitalized patients with COVID‐19. J Thromb Haemost. 2020;18(8):1995–2002. DOI: 10.1111/jth.14888. PMID: 32369666. 22. Ali M.A., Spinler S.A. COVID‐19 and thrombosis: From bench to bedside. Trends Cardiovasc Med. 2021;31(3):143–60. DOI: 10.1016/j. tcm.2020.12.004. PMID: 33338635. 23. Wool G. D., Miller J. L. The impact of COVID‐19 disease on platelets and coagulation. Pathobiology. 2021;88(1):15–27. DOI: 10.1159/000512007. PMID: 33049751. 24. Ahmed S., Zimba O., Gasparyan A.Y. Thrombosis in Coronavirus disease 2019 (COVID‐19) through the prism of Virchow’s triad. Clin Rheumatol. 2020;39(9):2529–43. DOI: 10.1007/s10067–020– 05275–1. PMID: 32654082. 25. Bonaventura A., Vecchié A., Dagna L. et al. Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID‐19. Nat Rev Immunol. 2021;21(5):319–29. DOI:10.1038/ s41577–021–00536–9. PMID: 33824483. 26. Babichev A.V. The role of endothelium in hemostasis mechanisms. Pediatr. 2013;4(1):122–7. (In Russ.). 27. Pober J.S., Sessa W.C. Evolving functions of endothelial cells in inflammation. Nat Rev Immunol. 2007;7(10):803–15. DOI: 10.1038/nri2171. PMID: 17893694. 28. Zou X., Chen K., Zou J. et al. Single‐cell RNA‐seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019‐nCoV infection. Front Med. 2020;14(2):185–92. DOI: 10.1007/s11684–020–0754–0.PMID: 32170560. 29. Zhu N., Zhang D., Wang W. et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727– 33. DOI: 10.1056/NEJMoa2001017. PMID: 31978945. 30. Varga Z., Flammer A.J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID‐19. Lancet. 2020;395(10234):1417–8. DOI: 10.1016/S0140–6736(20)30937–5. PMID: 32325026. 31. Zagidullin N. S., Gareeva D. F., Ishmetov V. S. et al. Reninangiotensin‐aldosterone system in new coronavirus infection 2019. Arterial’naya gipertenziya. 2020;26(3):240–7. (In Russ.). DOI: 10.18705/1607–419X‐2020–26–3–240–247. 32. Suzuki Y., Yasui H., Brzoska T. et al. Surface‐retained tPA is essential for effective fibrinolysis on vascular endothelial cells. Blood. 2011;118(11):3182–5. DOI: 10.1182/blood‐2011–05–353912. PMID: 21791417. 33. Petrov V.I., Gerasimenko A.S., Kulakova I.S. et al. Mechanisms of development of COVID‐19 associated coagulopathy. Diagnostics. Treatment. Lekarstvennyj vestnik. 2021;15(2):21–7. (In Russ.). 34. Kazimirsky A.N., Salmasi Zh.M., Poryadin G.V. Neutrophil extracellular traps are regulators of the formation of innate and adaptive immunity. RMZh. Medicinskoe obozrenie. 2020;(4):38–41. (In Russ.). DOI: 10.32364/2587–6821–2020–4–1–38–41. 35. von Brühl M.L., Stark K., Steinhart A. et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med. 2012;209(4):819–35. DOI: 10.1084/jem.20112322. PMID: 22451716. 36. Skendros P., Mitsios A., Chrysanthopoulou A. et al. Complement and tissue factor‐enriched neutrophil extracellular traps are key drivers in COVID‐19 immunothrombosis. J Clin Invest. 2020;130(11):6151–7. DOI: 10.1172/JCI141374. PMID: 32759504. 37. Bonaventura A., Liberale L., Carbone F. et al. The pathophysiological role of neutrophil extracellular traps in inflammatory diseases. Thromb Haemost. 2018;118(1):6–27. DOI: 10.1160/TH17– 09–0630. PMID: 29304522. 38. Fuchs T.A., Brill A., Duerschmied D. et al. Extracellular DNA traps promote thrombosis. Proc Natl Acad Sci U S A. 2010;107(36):15880– 5. DOI: 10.1073/pnas.1005743107. PMID: 20798043. 39. Nicolai L., Gaertner F., Massberg S. Platelets in host defense: experimental and clinical insights. Trends Immunol. 2019;40(10):922–38. DOI: 10.1016/j.it.2019.08.004. PMID: 31601520. 40. Guo L., Rondina M.T. The era of thromboinflammation: platelets are dynamic sensors and effector cells during infectious diseases. Front Immunol. 2019;10:2204. DOI: 10.3389/fimmu.2019.02204. PMID: 31572400. 41. Semple J.W., Aslam R., Kim M. et al. Platelet‐bound lipopolysaccharide enhances Fc receptor‐mediated phagocytosis of IgGopsonized platelets. Blood. 2007;109(11):4803–5. DOI: 10.1182/ blood‐2006–12–062695. PMID: 17299089. 42. Maier C.L., Truong A.D., Auld S.C. et al. COVID‐19‐associated hyperviscosity: a link between inflammation and thrombophilia? Lancet. 2020;395(10239):1758–9. DOI: 10.1016/S0140– 6736(20)31209–5. PMID: 32464112. 43. Forconi S., Pieragalli D., Guerrini M. et al. Primary and secondary blood hyperviscosity syndromes, and syndromes associated with blood hyperviscosity. Drugs. 1987;33 Suppl 2:19–26. DOI: 10.2165/00003495–198700332–00006. PMID: 3304953. 44. Manne B. K., Denorme F., Middleton E. A. et al. Platelet gene expression and function in patients with COVID‐19. Blood. 2020;136(11):1317–29. DOI: 10.1182/blood.2020007214. PMID: 32573711. 45. Zhang S., Liu Y., Wang X. et al. SARS‐CoV‐2 binds platelet ACE2 to enhance thrombosis in COVID‐19. J Hematol Oncol. 2020;13(1):120. DOI: 10.1186/s13045–020–00954–7. PMID: 32887634. 46. Zaid Y., Puhm F., Allaeys I. et al. Platelets can associate with SARS‐Cov‐2 RNA and are hyperactivated in COVID‐19. Circ Res. 2020;127(11):1404–18. DOI: 10.1161/CIRCRESAHA.120.317703. PMID: 32938299. 47. Shen B., Yi X., Sun Y. et al. Proteomic and metabolomic characterization of COVID‐19 patient sera. Cell. 2020;182(1):59–72.e15. DOI: 10.1016/j.cell.2020.05.032. PMID: 32492406. 48. Yan R., Zhang Y., Li Y. et al. Structural basis for the recognition of SARS‐CoV‐2 by full‐length human ACE2. Science. 2020;367(6485):1444–8. DOI: 10.1126/science.abb2762. PMID: 32132184. 49. Campbell R.A., Boilard E., Rondina M.T. Is there a role for the ACE2 receptor in SARS‐CoV‐2 interactions with platelets? J Thromb Haemost. 2021;19(1):46–50. DOI: 10.1111/jth.15156. PMID: 33119197. 50. Waldner M.J., Baethmann A., Uhl E., Lehmberg J. Bradykinininduced leukocyteand platelet‐endothelium interactions in the cerebral microcirculation. Brain Res. 2012;1448:163–9. DOI: 10.1016/j.brainres.2012.02.010. PMID: 22381894. 51. Sveshnikova A.N., Yakusheva A.A., Ryabykh A.A. et al. Modern views on the regulation of platelet‐dependent hemostasis. Kreativnaya kardiologiya. 2018;12(3):260–74. (In Russ.). DOI: 10.24022/1997–3187–2018–12–3–260–274. 52. Samorodov A.V., Zolotukhin K.N., Zabolotskiy D.V. et al. Specific parameters of the thromboelastographic profile of patients with COVID‐19 in the intensive care unit. Vestnik anesteziologii i reani matologii. 2020;17(6):39–44. (In Russ.). DOI: 10.21292/2078–5658– 2020–17–6–39–44. 53. Ranucci M., Ballotta A., Di Dedda U. et al. The procoagulant pattern of patients with COVID‐19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747–51. DOI: 10.1111/jth.14854. PMID: 32302448. 54. Zhou X., Cheng Z., Shu D. et al. Characteristics of mortal COVID‐19 cases compared to the survivors. Aging (Albany NY). 2020;12(24):24579–95. DOI: 10.18632/aging.202216. PMID: 33234724. 55. Taus F., Salvagno G., Canè S. et al. Platelets promote thromboinflammation in SARS‐CoV‐2 pneumonia. Arterioscler Thromb Vasc Biol. 2020;40(12):2975–89. DOI: 10.1161/ATVBAHA.120.315175. PMID: 33052054. 56. Rosell A., Havervall S., von Meijenfeldt F. et al. Patients with COVID‐19 have elevated levels of circulating extracellular vesicle tissue factor activity that is associated with severity and mortality‐brief report. Arterioscler Thromb Vasc Biol. 2021;41(2):878–82. DOI: 10.1161/ATVBAHA.120.315547. PMID: 33267656. 57. Kudlay D.A., Shirobokov Ya.E., Gladunova E.P., Borodulina E.A. Diagnosis of COVID‐19. Methods and problems of virus SARSCoV‐2 detection under pandemic conditions. Vrach. 2020;31(8):5– 10. (In Russ.). DOI: 10.29296/25877305–2020–08–01. 58. Bury L., Camilloni B., Castronari R. et al. Search for SARS‐CoV‐2 RNA in platelets from COVID‐19 patients. Platelets. 2021;32(2):284– 7. DOI: 10.1080/09537104.2020.1859104. PMID: 33349108. 59. Sirotkina O.V., Ermakov A.I., Gaykovaya L.V. et al. Microparticles of blood cells in patients with COVID‐19 as a marker of hemostasis activation. Tromboz, gemostaz i reologiya. 2020;(4):35–40. DOI: 10.25555/THR.2020.4.0943. 60. Hassanpour M., Rezaie J., Nouri M., Panahi Y. The role of extracellular vesicles in COVID‐19 virus infection. Infect Genet Evol. 2020;85:104422. DOI: 10.1016/j.meegid.2020.104422. PMID: 32544615. 61. Wang J., Chen S., Bihl J. Exosome‐mediated transfer of ACE2 (angiotensin‐converting enzyme 2) from endothelial progenitor cells promotes survival and function of endothelial cell. Oxid Med Cell Longev. 2020;2020:4213541. DOI: 10.1155/2020/4213541. PMID: 32051731. 62. Fujita Y., Hoshina T., Matsuzaki J. et al. Early prediction of COVID‐19 severity using extracellular vesicle COPB2. J Extra cell Vesicles. 2021;10(8):e12092. DOI: 10.1002/jev2.12092. PMID: 34122778.