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Fibrin clot characteristics and anticoagulant response in a SARS‐CoV‐2‐infected endothelial model

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posted on 2022-07-25, 01:41 authored by Conor McCafferty, Leo Lee, Tengyi Cai, Slavica Praporski, Julian Stolper, Vasiliki Karlaftis, Chantal Attard, David Myint, Leeanne CareyLeeanne Carey, David W Howells, Geoffrey A Donnan, Stephen Davis, Henry Ma, Sheila CrewtherSheila Crewther, Vinh NguyenVinh Nguyen, Suelyn Van Den Helm, Natasha Letunica, Ella Swaney, David Elliott, Kanta Subbarao, Vera Ignjatovic, Paul Monagle
Coronavirus disease 2019 (COVID-19) patients have increased thrombosis risk. With increasing age, there is an increase in COVID-19 severity. Additionally, adults with a history of vasculopathy have the highest thrombotic risk in COVID-19. The mechanisms of these clinical differences in risk remain unclear. Human umbilical vein endothelial cells (HUVECs) were infected with SARS-CoV-2, influenza A/Singapore/6/86 (H1N1) or mock-infected prior to incubation with plasma from healthy children, healthy adults or vasculopathic adults. Fibrin on surface of cells was observed using scanning electron microscopy, and fibrin characteristics were quantified. This experiment was repeated in the presence of bivalirudin, defibrotide, low-molecular-weight-heparin (LMWH) and unfractionated heparin (UFH). Fibrin formed on SARS-CoV-2 infected HUVECs was densely packed and contained more fibrin compared to mock-infected cells. Fibrin generated from child plasma was the thicker than fibrin generated in vasculopathic adult plasma (p = 0.0165). Clot formation was inhibited by LMWH (0.5 U/ml) and UFH (0.1-0.7 U/ml). We show that in the context of the SARS-CoV-2 infection on an endothelial culture, plasma from vasculopathic adults produces fibrin clots with thinner fibrin, indicating that the plasma coagulation system may play a role in determining the thrombotic outcome of SARS-CoV-2 infection. Heparinoid anticoagulants were most effective at preventing clot formation.


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This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. ©2022 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.

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