Abnormalities associated with blood clotting
According to the World Health Organization, more than 500 million individuals across the globe have been diagnosed with COVID-19 so far. Although estimates vary widely, a recent meta-analysis suggests that nearly one-third of all individuals with COVID-19 may experience persistent symptoms 3 months after symptom onset.
These COVID-19 symptoms that linger for at least three months after a SARS-CoV-2 infection have been collectively described as ‘long COVID Trusted Source’ or ‘post-acute COVID-19 syndrome Trusted Source’. Some common symptoms of long COVID include impaired exercise capacity, fatigue, breathlessness, muscle pain, brain fog, and headaches.
Despite the growing number of individuals with long COVID, the mechanisms underlying these persistent symptoms of COVID-19 are not well-understood.
Recent studies have shown that individuals with long COVID are more likely to develop small clots Trusted Source in blood capillaries and show abnormalities in the levels of factors that promote blood clotting. Such micro clots can interfere with the supply of oxygen and nutrients to the body and potentially result in long COVID symptoms such as fatigue.
Blood clotting factors
Acute COVID-19 is associated with an increased risk of blood clots. Consistently, individuals with acute COVID-19 are more likely to show elevated levels of proteins that promote blood clotting.
One such protein is the Factor (VWF), which helps to form a clot to seal off damaged blood vessels at the injury site. Subsequently, an enzyme called ADAMTS13 cleaves the VWF protein into smaller fragments to reduce its activity and prevent the formation of clots in blood vessels.
An elevated ratio of VWF to ADAMTS13 is associated with an increased risk of blood clots in acute COVID-19. Such a condition involving an increased risk of blood clots is referred to as a state.
In the present study, the authors investigated whether such a state was associated with the severity of long COVID symptoms, including exercise capacity.
Impaired exercise capacity
The present study consisted of 330 individuals who had persistent symptoms 3 or more months after the SARS-CoV-2 infection and were visiting an outpatient long COVID clinic. The majority (83%) had never been in hospital.
At the time of the visit, the researchers administered two tests to assess the participants’ endurance and exercise capacity. These exercise tests involved walking at a normal pace for 6 minutes and repeatedly switching from a sitting to a standing position for a minute.
The researchers used an oxygen monitor to measure blood oxygen levels during the test. They also measured changes in the levels of blood lactate, which is produced by the body when there is an insufficient supply of oxygen to sustain the activity of muscles.
To assess the risk of blood clotting, the researchers used blood samples to categorize the participants into two groups based on whether their VWF/ADAMTS13 ratio was normal less than or abnormal greater than or equal to
The researchers found that around 28% of the study’s participants had abnormal VWF/ADAMTS13 levels. The VWF/ADAMTS13 ratio was not correlated with the severity of long COVID symptoms, including headaches, fatigue, and cognitive deficits.
“The higher VWF/ADAMTS13 ratio may suggest that some long COVID patients have a predisposition to generation, potentially impairing the normal blood flow through various crucial areas such as lung or cerebral circulation. Thus, in normal condition, the patient may feel normal and compensated, whereas physical or mental effort may reveal a lack of compensatory reserve and produce characteristic symptoms.”
“Instead, the real long COVID mechanism may cause symptoms and increased ratio in some susceptible patients,”
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