Reduced ADAMTS13 Activity in Correlation with Pathophysiology, Severity, and Outcome of COVID-19: A Retrospective Observational Study

•Coagulopathy risk and microthrombosis were noticed in patients with COVID-19•ADAMTS13 and the VWF/ADAMTS13 axis could be connected to this risk•Low ADAMTS13 was linked to pneumonia, COVID-19 severity, and ventilation need•Recombinant ADAMTS13 could be a novel therapeutic strategy for Severe COVID-19 Low ADAMTS13 activity has been suggested to be an interplaying factor in the pathogenesis of COVID-19, considering that it is a thromboinflammatory disease with high risk of microthrombosis. The study aimed to explore the correlation between ADAMTS13 activity and the pathophysiological pathway of COVID-19. We carried out a retrospective observational study of 87 patients with COVID-19 in NMC Royal Hospital, Abu Dhabi, UAE. ADAMTS13 activity was measured and compared with patients’ characteristics and clinical outcomes. Low ADAMTS13 activity was associated with pneumonia (p = 0.007), severity of COVID-19 (p