The role of platelet-leukocyte aggregates in the pathogenesis of coagulopathy in COVID-19-patients

Abstract

Summary. Introduction. The formation of platelet-leukocyte aggregates (PLAs) in the systemic circulation of COVID-19 patients is considered one of the mechanisms potentiating coagulopathy and providing alternative pathways for thrombosis activation. Aim: to determine the contribution of peripheral blood PLAs to the development of coagulopathy in COVID-19-patients. Materials and Methods. A simple obser- vational study was conducted involving 93 patients with severe and critical COVID-19. Quantitative and phenotypic characterization of PLAs was performed using flow cytometry. The tissue factor (TF) and D-dimer concentrations were determined using the LEGENDplexTM Human Thrombosis Panel (BioLegend, USA). Levels of myeloperoxidase, matrix metalloproteinase-9 (MMP-9), and cystatin C were measured using

the LEGENDplexTM Human Vascular Inflammation Panel (BioLegend, USA) on a flow cytometer. Results. Based on thrombodynamics parame- ters, all patients were stratified into 4 groups: with expressed hypercoagulation, hypercoagulation, normal coagulation, and hypocoagulation. In the expressed hypercoagulation group the number of PLAs increased 2.5-fold (p < 0.01), while in the normal coagulation group, their number decreased 1.6-fold (p < 0.01) compared to the control group. A decreased number of lymphocyte-platelet and monocyte-platelet aggregates (primarily due to aggregates with pro-inflammatory and classical monocytes) was observed relative to the control group, with no significant differences between the patient groups. The number of neutrophil-platelet aggregates was increased in all groups with coagu- lation disorders (both in hyper- and hypocoagulation). Concurrently, an increase in the myeloperoxidase serum concentration was detected in all groups, with a maximum in the normal coagulation group, as well as an increase in the levels of MMP-9 and cystatin C, independent of the type of coagulopathy. TF content was elevated in all groups, reaching maximum values under hypocoagulation conditions. Conclu- sion. According to thrombodynamics data, various types of coagulopathies are developed in COVID-19 patients with PLAs contribution.

For citation: Tsybikov N.N., Fefelova E.V., Gaydukova T.V., Lukyanov S.A., Shapovalov K.G., Momot A.P., Tereshkov P.P. The role of platelet-leukocyte aggregates in the pathogenesis of coagulopathy in COVID-19-patients. Tromboz, gemostaz i reologiya. 2025;(4):29–38. (In Russ.).

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