High levels of plasminogen activator inhibitor-1, tissue plasminogen activator and fibrinogen in patients with severe COVID-19

Abstract

We measured plasma levels of fibrinogen, plasminogen, tissue plasminogen activator (t-PA) and plasminogen activation inhibitor 1 (PAI-1) in blood from 37 patients with severe coronavirus disease-19 (COVID-19) and 23 controls. PAI-1, t-PA and fibrinogen levels were significantly higher in the COVID-19 group. Increased levels of PAI-1 likely result in lower plasmin activity and hence decreased fibrinolysis. These observations provide a partial explanation for the fibrin-mediated increase in blood viscosity and hypercoagulability that has previously been observed in COVID-19. Our data suggest that t-PA administration may be problematic, but that other interventions designed to enhance fibrinolysis might prove useful in the treatment of the coagulopathy that is often associated with severe COVID-19.

Novel prognostic determinants of COVID-19-related mortality: a pilot study on severely-ill patients in Russia

“…While Umemura et al reported an unchanged PAI-1 level in COVID-19 patients 52 , several other groups detected the increased levels of PAI-1, tPA and uPA in COVID-19 patients as compared to heathy controls 53,54 . Zou and co-authors demonstrated that high levels of tPA and PAI-1 were associated with worse respiratory status in patients hospitalized with COVID-19 48 .…”

Hypercoagulation detected by Rotational Thromboelastometry predicts mortality in COVID-19: A risk model based on a prospective observational study

“…Indeed, earlier reports suggest that elevated levels of plasminogen activator inhibitor type 1 (PAI-1), which is one of the most important inhibitors of the fibrinolytic system, may result in lower plasmin activity and hence decreased fibrinolysis. This in turn, may contribute to an imbalance between coagulation and fibrinolysis in COVID-19 (23).…”

Novel prognostic determinants of COVID-19-related mortality: A pilot study on severely-ill patients in Russia

“…Hyperfibrinolysis resulting from excessive plasmin activity is also associated with elevated D-dimer in severely-ill COVID-19 patients. While Umemura et al reported an unchanged PAI-1 level in COVID-19 patients [54], several other groups detected the increased levels of PAI-1, tPA and uPA in COVID-19 patients as compared to heathy controls [55,56]. Zou and co-authors demonstrated that high levels of tPA and PAI-1 were associated with worse respiratory status in patients hospitalized with COVID-19 [50].…”