Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)
2022, Clinical cases
2022

Anticoagulant treatment for severe COVID‐19 with high bleeding risk: 616-06

Clinical cases
Published 2022-03-28
Vladimir Kolesnikov
Samara Region «Togliatti City Clinical Hospital No 5»; Samara State Medical University, Health Ministry of Russian Federation
ГБУЗ Самарской области «Тольяттинская городская клиническая больница No 5»; 2ФГБОУ ВО «Самарский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Eugene Roitman
Pirogov Russian National Research Medical University, Health Ministry of Russian Federation; Research Center of Neurology
ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации; 4ФГБНУ «Научный центр неврологии»
Aleksey Leonov
Samara Region «Togliatti City Clinical Hospital No 5»
ГБУЗ Самарской области «Тольяттинская городская клиническая больница No 5»

Keywords

COVID‐19
bleeding
anticoagulant therapy
  Full Text

Abstract

Summary. Anticoagulant therapy in severe COVID-19 raises bleeding risk. We considered 16 medical stories of inhospital patients with severe COVID-19 complicated with bleeding. Anticoagulant treatment with mainly low molecular weight heparins (LMWHs) in therapeutic doses was performed for all of them. Main revealed causes for hemorrhagic complications were invasive interven- tions, and tissue compression due to prone position, and an excessive anticoagulation with anti-Xa>1.0 ME/mL. Anticoagulant excess was developed because of what the creatinine clearance was not considered for LMWHs dosing. Obtained results show the thrombotic/bleeding risk ratio together with renal function should be evaluated mandatory before anticoagulant starting in patients with severe COVID-19. In such patients LMWHs doses have to be adjusted so that the anti-Xa don’t exceed 1.0 ME/mL. With caution we guess joint pharmacological and mechanical (including the intermittent pneumatic compression) antithrombotic prophylaxis is able to lower bleeding risk in patients with severe COVID-19.

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