Potential role for tissue factor in the pathogenesis of hypercoagulability associated with in COVID-19

J Thromb Thrombolysis. 2020 Oct;50(3):479-483. doi: 10.1007/s11239-020-02172-x.


In December 2019, a new and highly contagious infectious disease emerged in Wuhan, China. The etiologic agent was identified as a novel coronavirus, now known as Severe Acute Syndrome Coronavirus-2 (SARS-CoV-2). Recent research has revealed that virus entry takes place upon the union of the virus S surface protein with the type I transmembrane metallo-carboxypeptidase, angiotensin converting enzyme 2 (ACE-2) identified on epithelial cells of the host respiratory tract. Virus triggers the synthesis and release of pro-inflammatory cytokines, including IL-6 and TNF-α and also promotes downregulation of ACE-2, which promotes a concomitant increase in levels of angiotensin II (AT-II). Both TNF-α and AT-II have been implicated in promoting overexpression of tissue factor (TF) in platelets and macrophages. Additionally, the generation of antiphospholipid antibodies associated with COVID-19 may also promote an increase in TF. TF may be a critical mediator associated with the development of thrombotic phenomena in COVID-19, and should be a target for future study.

Keywords: COVID-19; IL-6; SARS-CoV-2; TNF-α; Thrombosis; Tissue factor.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2
  • Animals
  • Betacoronavirus / pathogenicity*
  • Blood Coagulation* / drug effects
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / blood
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / virology*
  • Cytokines / metabolism
  • Fibrinolytic Agents / therapeutic use
  • Host-Pathogen Interactions
  • Humans
  • Inflammation Mediators / metabolism
  • Pandemics
  • Peptidyl-Dipeptidase A / metabolism
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / virology*
  • SARS-CoV-2
  • Thromboplastin / metabolism*
  • Thrombosis / blood
  • Thrombosis / diagnosis
  • Thrombosis / drug therapy
  • Thrombosis / virology*


  • Cytokines
  • Fibrinolytic Agents
  • Inflammation Mediators
  • Thromboplastin
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2