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Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis

Post-COVID syndrome (PCS), or long COVID, is an increasingly recognized complication of acute SARS-CoV-2 infection, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath, and cognitive slowing. Acute COVID-19 is strongly linked with an increased risk of thr...

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Autores principales: Prasannan, Nithya, Heightman, Melissa, Hillman, Toby, Wall, Emma, Bell, Robert, Kessler, Anna, Neave, Lucy, Doyle, Andrew, Devaraj, Akshitha, Singh, Deepak, Dehbi, Hakim-Moulay, Scully, Marie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098525/
https://www.ncbi.nlm.nih.gov/pubmed/35543533
http://dx.doi.org/10.1182/bloodadvances.2021006944
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author Prasannan, Nithya
Heightman, Melissa
Hillman, Toby
Wall, Emma
Bell, Robert
Kessler, Anna
Neave, Lucy
Doyle, Andrew
Devaraj, Akshitha
Singh, Deepak
Dehbi, Hakim-Moulay
Scully, Marie
author_facet Prasannan, Nithya
Heightman, Melissa
Hillman, Toby
Wall, Emma
Bell, Robert
Kessler, Anna
Neave, Lucy
Doyle, Andrew
Devaraj, Akshitha
Singh, Deepak
Dehbi, Hakim-Moulay
Scully, Marie
author_sort Prasannan, Nithya
collection PubMed
description Post-COVID syndrome (PCS), or long COVID, is an increasingly recognized complication of acute SARS-CoV-2 infection, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath, and cognitive slowing. Acute COVID-19 is strongly linked with an increased risk of thrombosis, which is a prothrombotic state quantified by an elevated von Willebrand factor (VWF) antigen (Ag)/ADAMTS13 ratio that is associated with severity of acute COVID-19 infection. We investigated whether patients with PCS also had evidence of a prothrombotic state associated with symptom severity. In a large cohort of patients referred to a dedicated post-COVID-19 clinic, thrombotic risk, including VWF(Ag)/ADAMTS13 ratio, was investigated. An elevated VWF(Ag)/ADAMTS13 ratio (≥1.5) was present in nearly one-third of the cohort and was 4 times more likely to be present in patients with impaired exercise capacity, as evidenced by desaturation ≥3% and/or an increase in lactate level >1 from baseline on a 1-minute sit-to-stand test and/or a 6-minute walk test (P < .0001). Of 276 patients, 56 (20%) had impaired exercise capacity, of which 55% (31/56) had a VWF(Ag)/ADAMTS13 ratio ≥1.5 (P < .0001). Factor VIII and VWF(Ag) were elevated in 26% and 18%, respectively, and support a hypercoagulable state in some patients with PCS. These findings suggest possible ongoing microvascular/endothelial dysfunction in the pathogenesis of PCS and suggest a role for antithrombotic therapy in the treatment of these patients.
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spelling pubmed-90985252022-05-13 Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis Prasannan, Nithya Heightman, Melissa Hillman, Toby Wall, Emma Bell, Robert Kessler, Anna Neave, Lucy Doyle, Andrew Devaraj, Akshitha Singh, Deepak Dehbi, Hakim-Moulay Scully, Marie Blood Adv Thrombosis and Hemostasis Post-COVID syndrome (PCS), or long COVID, is an increasingly recognized complication of acute SARS-CoV-2 infection, characterized by persistent fatigue, reduced exercise tolerance, chest pain, shortness of breath, and cognitive slowing. Acute COVID-19 is strongly linked with an increased risk of thrombosis, which is a prothrombotic state quantified by an elevated von Willebrand factor (VWF) antigen (Ag)/ADAMTS13 ratio that is associated with severity of acute COVID-19 infection. We investigated whether patients with PCS also had evidence of a prothrombotic state associated with symptom severity. In a large cohort of patients referred to a dedicated post-COVID-19 clinic, thrombotic risk, including VWF(Ag)/ADAMTS13 ratio, was investigated. An elevated VWF(Ag)/ADAMTS13 ratio (≥1.5) was present in nearly one-third of the cohort and was 4 times more likely to be present in patients with impaired exercise capacity, as evidenced by desaturation ≥3% and/or an increase in lactate level >1 from baseline on a 1-minute sit-to-stand test and/or a 6-minute walk test (P < .0001). Of 276 patients, 56 (20%) had impaired exercise capacity, of which 55% (31/56) had a VWF(Ag)/ADAMTS13 ratio ≥1.5 (P < .0001). Factor VIII and VWF(Ag) were elevated in 26% and 18%, respectively, and support a hypercoagulable state in some patients with PCS. These findings suggest possible ongoing microvascular/endothelial dysfunction in the pathogenesis of PCS and suggest a role for antithrombotic therapy in the treatment of these patients. American Society of Hematology 2022-07-11 /pmc/articles/PMC9098525/ /pubmed/35543533 http://dx.doi.org/10.1182/bloodadvances.2021006944 Text en © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. https://www.ncbi.nlm.nih.gov/pmc/pmcdoc/tagging-guidelines/article/tags.html#el-licenseThis article is made available via the PMC Open Access Subset for unrestricted reuse and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Thrombosis and Hemostasis
Prasannan, Nithya
Heightman, Melissa
Hillman, Toby
Wall, Emma
Bell, Robert
Kessler, Anna
Neave, Lucy
Doyle, Andrew
Devaraj, Akshitha
Singh, Deepak
Dehbi, Hakim-Moulay
Scully, Marie
Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title_full Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title_fullStr Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title_full_unstemmed Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title_short Impaired exercise capacity in post–COVID-19 syndrome: the role of VWF-ADAMTS13 axis
title_sort impaired exercise capacity in post–covid-19 syndrome: the role of vwf-adamts13 axis
topic Thrombosis and Hemostasis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098525/
https://www.ncbi.nlm.nih.gov/pubmed/35543533
http://dx.doi.org/10.1182/bloodadvances.2021006944
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