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Cited by 80COVID-19 Clinical Research StudiesBlood Coagulation and Thrombosis MechanismsVenous Thromboembolism Diagnosis and Management

Marked factor V activity elevation in severe COVID‐19 is associated with venous thromboembolism

Open access
Stefely, Jonathan A., Christensen, Bianca B., Gogakos, Tasos, Cone Sullivan, Jensyn K., Montgomery, Gabriella G., Barranco, John P., Van Cott, Elizabeth M.·2020·American Journal of Hematology
DOI 10.1002/ajh.25979PMC PMC7461432
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Abstract

Coagulopathy causes morbidity and mortality in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Yet, the mechanisms are unclear and biomarkers are limited. Early in the pandemic, we observed markedly elevated factor V activity in a patient with COVID-19, which led us to measure factor V, VIII, and X activity in a cohort of 102 consecutive inpatients with COVID-19. Contemporaneous SARS-CoV-2-negative controls (n = 17) and historical pre-pandemic controls (n = 260-478) were also analyzed. This cohort represents severe COVID-19 with high rates of ventilator use (92%), line clots (47%), deep vein thrombosis or pulmonary embolism (DVT/PE) (23%), and mortality (22%). Factor V activity was significantly elevated in COVID-19 (median 150 IU/dL, range 34-248 IU/dL) compared to contemporaneous controls (median 105 IU/dL, range 22-161 IU/dL) (P < .001)-the strongest association with COVID-19 of any parameter studied, including factor VIII, fibrinogen, and D-dimer. Patients with COVID-19 and factor V activity >150 IU/dL exhibited significantly higher rates of DVT/PE (16/49, 33%) compared to those with factor V activity ≤150 IU/dL (7/53, 13%) (P = .03). Within this severe COVID-19 cohort, factor V activity associated with SARS-CoV-2 load in a sex-dependent manner. Subsequent decreases in factor V were linked to progression toward DIC and mortality. Together, these data reveal marked perturbations of factor V activity in severe COVID-19, provide links to SARS-CoV-2 disease biology and clinical outcomes, and nominate a candidate biomarker to investigate for guiding anticoagulation therapy in COVID-19.

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  • The increase in factor X activity was correlated with an increase in acute phase reactants.

    “Additionally, an increase in factor X activity was shown, but not correlated with an increase in factor V activity, but with an increase in acute phase reactants, suggesting distinct pathophysiological mechanisms [74].”

    From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [74]

  • The increase in factor X activity was not correlated with an increase in factor V activity.

    “Additionally, an increase in factor X activity was shown, but not correlated with an increase in factor V activity, but with an increase in acute phase reactants, suggesting distinct pathophysiological mechanisms [74].”

    From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [74]

  • An increase in factor X activity was shown in COVID-19 patients.

    “Additionally, an increase in factor X activity was shown, but not correlated with an increase in factor V activity, but with an increase in acute phase reactants, suggesting distinct pathophysiological mechanisms [74].”

    From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [74]

  • The correlation of factor X activity with acute phase reactants suggests distinct pathophysiological mechanisms.

    “Additionally, an increase in factor X activity was shown, but not correlated with an increase in factor V activity, but with an increase in acute phase reactants, suggesting distinct pathophysiological mechanisms [74].”

    From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [74]

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Authors
Stefely, J. A., Christensen, B. B., Gogakos, T., Cone Sullivan, J. K., Montgomery, G. G., Barranco, J. P., & Van Cott, E. M.
Affiliations
  • Harvard University (US)
  • Department of Pathology, Coagulation Laboratory Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
ORCID
Venue
American Journal of Hematology
Publisher
Wiley
Published
2020-09-18
Volume
95
Issue
12
Pages
1522-1530
ISSN
  • 0361-8609 (ISSN-L)
  • 1096-8652
DOI
10.1002/ajh.25979
PMC
PMC7461432
OpenAlex
W3080948832
Cited by
80
References
43
Citations by year
2025: 2 · 2024: 11 · 2023: 12 · 2022: 29 · 2021: 24 · 2020: 2
FWCI
2.19
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • American Journal of Hematology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords
COVID-19 pandemic, SARS-CoV-2, factor V activity, venous thromboembolism, deep vein thrombosis, pulmonary embolism, coagulopathy, disseminated intravascular coagulation, factor VIII, factor X, D-dimer, fibrinogen, biomarkers, anticoagulation, mortality, sex differences, viral load
MeSH terms
COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Disseminated Intravascular Coagulation, Factor V, Female, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Embolism, Respiration, Artificial, Severity of Illness Index, Sex Factors, Extracorporeal Membrane Oxygenation, Cohort Studies, Venous Thrombosis, Venous Thromboembolism

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