Journal of thrombosis and thrombolysisNov 5, 2020

Neutrophil traps linked to blood clots in COVID-19

Updated Jan 17, 2026

Abstract

Elevated levels of neutrophil-derived substances in sera were associated with a higher risk of thrombotic events in patients with COVID-19.

Patients hospitalized with COVID-19 who developed thrombosis exhibited higher levels of neutrophil extracellular traps (NETs).
Cell-free DNA, myeloperoxidase-DNA complexes, and citrullinated histone H3 remnants were found in patients with thrombosis.
The presence of neutrophil-derived S100A8/A9 (calprotectin) was also linked to an increased risk of thrombotic events.
These findings suggest a potential role of hyperactive neutrophils and NET release in COVID-19-associated thrombosis.
Prophylactic anticoagulation did not eliminate the risk of thrombotic events in these patients.

Simplified

Studies of patients with COVID-19 have demonstrated markedly dysregulated coagulation and a high risk of morbid arterial and venous thrombotic events. Elevated levels of blood neutrophils and neutrophil extracellular traps (NETs) have recently been described in patients with COVID-19. However, their potential role in COVID-19-associated thrombosis remains incompletely understood. In order to elucidate the potential role of hyperactive neutrophils and NET release in COVID-19-associated thrombosis, we conducted a case-control study of patients hospitalized with COVID-19 who developed thrombosis, as compared with gender- and age-matched COVID-19 patients without clinical thrombosis. We found that remnants of NETs (cell-free DNA, myeloperoxidase-DNA complexes, and citrullinated histone H3) and neutrophil-derived S100A8/A9 (calprotectin) in patient sera were associated with higher risk of morbid thrombotic events in spite of prophylactic anticoagulation. These observations underscore the need for urgent investigation into the potential relationship between NETs and unrelenting thrombosis in COVID-19, as well as novel approaches for thrombosis prevention.

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Neutrophil traps linked to blood clots in COVID-19

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