Effect of anticoagulant prophylaxis on hemostasis activation in the acute period of coronavirus infection: 615.273.52:616-005.2:616.9

Abstract

Summary. Background. High prothrombotic status, called COVID-19-associated coagulopathy is a specialty of novel coronavirus infection COVID-19, that results in a high incidence of thrombotic events, in particular, venous thromboembolic complications. Therefore, antithrombotic prophylaxis has become widespread. For this purpose, low molecular weight heparins (LMWHs) are most often used, the doses of which remain controversial. Objective: assessment of anticoagulant prophylaxis effect on the degree of hemostasis activation in patients with COVID-19 in the acute disease period. Patients/Methods. The observational study included 165 patients with severe and moderate course of coronavirus infection. The first blood sampling was carried out in all 165 patients (group 1) on admission to the hospital before the start of therapy. Under anticoagulant prophylaxis, some patients (n = 43; group 2) were examined on days 3–5 and some (n = 40; group 3) on days 8–10 of hospital stay. The following hemostasis parameters were determined: level of fibrinogen, free protein S and D-dimer, activity of factor VIII (FVIII), antithrombin, protein C, von Willebrand factor (vWF) activity and antigen, and thrombin generation by calibrated automated thrombinography. Blood plasma samples from 68 healthy individuals matched by sex and age were used as control. Results. Compared with healthy individuals, patients of group 1 (on admission to the hospital) showed increased fibrinogen concentration, vWF activity and antigen, FVIII activity and D-dimer content, a significant decreased free protein S level, increased thrombin generation, and decreased sensitivity to thrombomodulin. These procoagulant changes persisted on days 3–5 of the disease (group 2). On days 8–10 (group 3), a downward trend was identified for some parameters, nevertheless they remained significantly higher than in healthy individuals; at the same time the absence of thrombinemia was noted. Conclusions. Significant prothrombotic changes are observed in patients in the acute period of COVID-19, that persist for 3–5 days of hospitalization. On days 8–10, despite therapy, a high level of hypercoagulation markers remains. At the same time, the integrated thrombin generation test unambiguously indicates the absence of thrombinemia, which, in turn, points to the effectiveness of antithrombotic prophylaxis. The appointment of high prophylactic LMWHs doses seems to be justified, effective and safe.

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