top of page


High plasma levels of Activated Factor VII-Antithrombin Complex Point to increased Tissue Factor Expression in patients with SARS-CoV-2 pneumonia: a potential link with COVID-19 Prothrombotic Diathesis

Martinelli N, Rigoni AM, De Marchi S, Osti N, Donini M, Montagnana M,  Castagna A, Pattini P, Udali S, De Franceschi L, Tinazzi E, Mazzi F,  Moruzzi S, Argentino G, Delfino L, Sartori G, Azzini AM, Tacconelli E,  Van Dreden P, Lippi G, Girelli D, Olivieri O, Friso S, Pizzolo F

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the  causal agent of coronavirus disease 2019 (COVID-19), in which  coagulation abnormalities and endothelial dysfunction play a key  pathogenic role. Tissue factor (TF) expression is triggered by  endothelial dysfunction. Activated factor VII-antithrombin (FVIIa-AT)  complex reflects indirectly FVIIa-TF interaction and has been proposed  as a potential biomarker of prothrombotic diathesis. FVIIa-AT plasma  concentration was measured in 40 patients (30 males and 10 females; 64.8  ± 12.3 years) admitted with SARS-CoV-2 pneumonia during the first  pandemic wave in Italy. Two sex- and age-matched cohorts without  COVID-19, with or without signs of systemic inflammation, were used to  compare FVIIa-AT data. The FVIIa-AT plasma levels in COVID-19 patients  were higher than those in non-COVID-19 subjects, either with or without  inflammation, while no difference was observed among non-COVID-19  subjects. The association between COVID-19 and FVIIa-AT levels remained  significant after adjustment for sex, age, C-reactive protein, renal  function, fibrinogen, prothrombin time and activated partial  thromboplastin time. Our results indicate that SARS-CoV-2 infection, at  least during the first pandemic wave, was characterized by high FVIIa-AT  levels, which may suggest an enhanced FVIIa-TF interaction in COVID-19,  potentially consistent with SARS-CoV-2-induced endotheliopathy.

Keywords: activated factor VII-antithrombin (FVIIa-AT); coagulation; coronavirus disease 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); tissue factor (TF).

bottom of page