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Patients with Coronavirus-associated disease-2019 (COVID-19) display alterations of the hemostatic system and the presence of a prothrombotic status frequently leading to vascular complications. However, the impact of COVID-19 on platelet activity, aggregation and agglutination still needs to be clarified. We measured total levels of von Willebrand factor (vWF) and vWF binding to the platelet glycoprotein (Gp) complex (GPIb-IX-V), in a cohort of COVID-19 patients admitted to the intensive care unit of our Institution. Moreover, we evaluated platelet aggregation in response to agonists (ADP, collagen, arachidonic acid) and platelet agglutination in response to ristocetin. We found that levels of vWF antigen and the active form of vWF binding to platelets (vWF:RCo), were markedly increased in these patients. These results were associated with higher agglutination rates induced by ristocetin, thereby indirectly indicating an increased capability of vWF to bind to platelets. Conversely, we found that platelet aggregation in response to both ADP and collagen was lower in COVID-19 patients compared to healthy volunteers. This study shows that COVID-19 is associated with increased vWF-induced platelet agglutination but reduced platelet responsivity to aggregation stimuli. Our findings have translational relevance since platelet adhesion to vWF may represent a marker to predict possible complications and better delineate therapeutic strategies in COVID-19 patients. Electronic Supplementary Material The online version of this article (10.1007/s11239-020-02339-6) contains supplementary material, which is available to authorized users.

Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

Most gastric cancer patients suffer tumor recurrence after gastrectomy. Prognosis seems to be closely correlated to the presence of free cancer cells in the peritoneal washing liquid at the time of surgery. The gastric resection itself permits the release of tumor emboli that are more easily implanted on the abraded peritoneal surfaces during the immediate postoperative period. Postoperative intraperitoneal chemotherapy, if administered in an effective dose, should provide a broad drug distribution to all the abdominal surfaces and so change the outcome of the disease. A phase II study was conducted to evaluate regional and systemic toxicity of postoperative intraperitoneal chemotherapy. Twenty four patients with locally advanced gastric cancer were treated with intraperitoneal 5-fluorouracil (5-FU) and folinic acid, following radical surgery. In 10 patients, the drug was infused at a dose of 20 mg/Kg/day, together with folinic acid, 125 mg/m2/day for 5 days every 28 days (maximum: 6 cycles), starting on the 21st postoperative day. Toxicity was moderate and no anastomotic leakage was observed. In remaining 14 patients, treatment started on the first postoperative day for 5 days with 5-FU dose reduced to 13.5 mg/Kg/day without changing the folinic acid doses. This second group showed a lower myelotoxicity rate than the first, although the incidence of both diarrhea and abdominal pain was higher. Overall toxicity was greater than grade 1 in only 2 patients, in one of whom treatment was discontinued. Nineteen patients are alive and apparently disease-free at a median follow-up of 22.5 months.