Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)
2022, Original papers
2022

Coagulopathy and risk factors in patients with severe COVID‐19: 616.151.511-02:616.988

Original papers
Published 2023-02-22
Roman E. Kalinin
Pavlov Ryazan State Medical University, Health Ministry of Russian Federation;9 Vysokovoltnaya Str., Ryazan 390026, Russia;
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Россия, 390026 Рязань, ул. Высоковольтная, 9;
https://orcid.org/0000-0002-0817-9573 (unauthenticated)
Igor A. Suchkov
Pavlov Ryazan State Medical University, Health Ministry of Russian Federation;9 Vysokovoltnaya Str., Ryazan 390026, Russia;
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Россия, 390026 Рязань, ул. Высоковольтная, 9;
https://orcid.org/0000-0002-1292-5452 (unauthenticated)
Andrey B. Agapov
Ryazan Regional Clinical Hospital; 3а Internatsionalnaya Str., Ryazan 390039, Russia;
ГБУ Рязанской области «Областная клиническая больница»; Россия, 390039 Рязань, ул. Интернациональная, 3а;
Nina D. Mzhavanadze
Pavlov Ryazan State Medical University, Health Ministry of Russian Federation;9 Vysokovoltnaya Str., Ryazan 390026, Russia; Ryazan City Clinical Emergency Hospital; 11 Dzerzhinsky Str., Ryazan 3900139, Russia
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Россия, 390026 Рязань, ул. Высоковольтная, 9; ГБУ Рязанской области «Городская клиническая больница скорой медицинской помощи»;Россия, 390013 Рязань, ул. Дзержинского, 11
Denis A. Maksaev
Pavlov Ryazan State Medical University, Health Ministry of Russian Federation;9 Vysokovoltnaya Str., Ryazan 390026, Russia; Ryazan City Clinical Emergency Hospital; 11 Dzerzhinsky Str., Ryazan 3900139, Russia
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Россия, 390026 Рязань, ул. Высоковольтная, 9; ГБУ Рязанской области «Городская клиническая больница скорой медицинской помощи»;Россия, 390013 Рязань, ул. Дзержинского, 11
Artyom A. Chobanyan
Pavlov Ryazan State Medical University, Health Ministry of Russian Federation;9 Vysokovoltnaya Str., Ryazan 390026, Russia; Ryazan City Clinical Emergency Hospital; 11 Dzerzhinsky Str., Ryazan 3900139, Russia
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Россия, 390026 Рязань, ул. Высоковольтная, 9; ГБУ Рязанской области «Городская клиническая больница скорой медицинской помощи»;Россия, 390013 Рязань, ул. Дзержинского, 11

Keywords

novel coronavirus infection COVID‐19
thromboses
bleedings
anticoagulant therapy
  Full Text

Abstract

Summary. Background. The pandemic of novel coronavirus infection (NCI) COVID-19 is accompanied by a high risk of thrombosis and bleeding. The debate regarding the choice of dose of anticoagulant therapy in severe patients with NCI is ongoing at present. Objective: to assess coagulation parameters and identify risk factors in patients with severe COVID-19. Patients/Methods. Out of 370 patients with NCI COVID-19 treated in Ryazan covid hospitals in 2021, 173 (46.8%) patients with severe coronavirus infection were included in the retrospective study. Risk factors, the frequency of thrombotic complications and bleeding, laboratory param- eters of hemostasis and inflammation (general blood analysis, blood biochemistry, coagulogram), dose variants of anticoagulant therapy (preventive, intermediate and therapeutic doses) were accessed. Results. Among 173 patients with severe COVID-19, 98 (56.7%) persons recovered, and 75 (43.3%) patients died. In non-survivors vs. survivors, hypertension was more often observed — in 64 (85.3%) cases (p = 0.043), as well as obesity — in 8 (50.7%) cases (p = 0.024) and type 2 diabetes mellitus — in 34 (45.3%) cases (p=0.022), therapeutic dosage of anticoagulants was used more often (58.6% of cases). C-reactive protein (CRP) level on admis- sion was significantly higher in non-survivors vs. survivors — 117.3 (185–356) mg/L vs. 90.4 (1.2–301.0) mg/L (p = 0.033) as well as fibrinogen content — 6.3 (1.3–10.0) g/L vs. 3.6 (1.1–12.0) g/L (p = 0.004). In patients with lethal outcome, pulmonary embolism (PE) without a source in the lower extremities was determined more often than in patients with favorable outcome — 10 (13.3%) vs. 0 (0%) cases (p=0.002). Isolated deep vein thrombosis (DVT) occurred only in patients with favorable outcome. The analysis of hemorrhagic complications revealed that the frequency of major bleeding was higher among non-survivors vs. survivors — 7 (9.3%) vs. 2 (2.04%) cases (p=0.032). Conclusions. The use of therapeutic doses of anticoagulants did not reduce the mortality rate in severe patients with NCI and was accompanied by PE development with and without a source in the lower extremities in 15 (20%) cases. High levels of CRP, fibrinogen, D-dimer, and low platelet count are predictive laboratory markers of unfavorable outcome in patients with severe NCI.

For citation: Kalinin R.E., Suchkov I.A., Agapov A.B., Mzhavanadze N.D., Maksaev D.A., Chobanyan A.A. Coagulopathy and risk factors in patients with severe COVID-19. Tromboz, gemostaz i reologiya. 2022;(4):64–74. (In Russ.).

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