Coagulopathy and risk factors in patients with severe COVID-19

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 parameters 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 admission 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. © Kalinin R.E., Suchkov I.A., Agapov A.B., Mzhavanadze N.D., Maksaev D.A., Chobanyan A.A., 2022 © Gemostaz i Reologia LLC, 2022.

The Effectiveness of Compression Therapy in the Prevention of Venous Thromboembolic Complications in Patients With COVID-19

BACKGROUND The main method for preventing thrombotic complications in patients with coronavirus infection is anticoagulant therapy (ACT). However, its use is not always possible, in particular in patients with bleeding. The only method of prevention in this case is elastic compression (EC) of the lower extremities. AIM OF STUDY To evaluate the effectiveness of lower extremity EC for the prevention of venous thromboembolic complications (VTEC) in patients with a new coronavirus infection. MATERIAL AND METHODS The study was approved by the local Ethics Committee of the Ryazan State Medical University of the Ministry of Health of Russian Federation and registered on the ClinicalTrials.gov platform (identifier NCT05143567). The study included 69 patients without prophylactic compression (Group 1) and 65 patients who used prophylactic compression stockings (Group 2). The patients were treated in the covid hospital from July to November 2021. All patients had verified coronavirus infection, they took ACT and underwent ultrasound duplex scanning of the veins of the lower extremities upon admission, in the intensive care unit and upon discharge. We assessed the frequency of venous thromboembolic complications (VTEC), hemorrhagic complications, and mortality. To assess the severity of bleeding, the classification of the Committee of the International Society on Thrombosis and Haemostasis (ISTH) was used. RESULTS In patients without prophylactic compression (Group 1) there were 7 VTEC cases (10.14%);deep vein thrombosis (DVT) — 4 (5.8%), pulmonary embolism (PE) — 3 (4.3%). All 6 cases (8.7%) with PE were fatal. It was noted that 2 cases of PE (2.8%) were verified upon autopsy, and not clinically. In patients of the 2nd group with the use of elastic compression, the overall incidence of VTEC was only one case (1.6%). When analyzing the frequency of bleeding in the 1st group, there was one pulmonary bleeding (1.4%), in the 2nd group there was also one case of intense intermuscular hematoma (1.6%). Significant bleeding was observed in one patient (1.4%) of the 1st group, and in 3 (4.8%) cases of the 2nd group. The minor bleeding was observed in 11 patients (15.9%) of the 1st group, and in 8 (12.7%) patients of the 2nd group. The mortality during hospitalization was 11 (15.9%) cases in patients of the 1st group (without EC) and 7 (11.1%) in patients of the 2nd group (with EC) (p=0.419). CONCLUSIONS The mortality in patients with coronavirus infection without compression therapy is higher than in patients with compression stockings (p=0.419). Patients wearing compression stockings in the hospital had a low incidence of VTEC (1.6% of cases in group 2 versus 10.14% of cases in group 1, p=0.039). The study groups had the same frequency of bleeding (group 1 — one case (1.4%), group 2 — one case (1.6%). The use of preventive compression at the inpatient stage of treatment of a new coronavirus infection makes it possible to prevent VTEC in patients with bleeding when anticoagulant therapy is not possible. © 2022 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Venous Thromboembolism in COVID-19 Patients During the First and the Second Waves of the Pandemic: Real-Practice Data

Objective. To analyze the incidence, structure, course and outcomes of venous thromboembolism (VTE) in patients with a novel coronavirus infection (COVID-19) during the first and the second waves of the pandemic, to identify and evaluate the features of laboratory data. Material and methods. We assessed instrumental and laboratory data in COVID-19 patients during the first (1839 patients) and the second (840 patients) waves of the pandemic. Mortality, localization of thrombosis, variants of anticoagulation and laboratory data (leukocytes, C-reactive protein, fibrinogen, ferritin) were analyzed. Results. VTE occurred in 27 (1.5%) and 13 (1.5%) patients with a novel coronavirus infection during the first and the second waves of the pandemic, respectively. In the first wave, thromboembolic events included deep vein thrombosis (DVT) in 16 (59%) cases, pulmonary embolism (PE) in 6 (22%) cases, DVT + PE in 2 (8%) patients, saphenous vein thrombophlebitis in 3 (11%) cases. In the second wave, DVT was detected in 5 (38.5%) patients, DVT+PE in 5 (38.5%) cases, PE without DVT in 2 (15.4%) patients and thrombosis of the right renal vein in 1 (7.6%) patient. In the first wave, mean leukocyte count was 9.2 x 109/L (6.9—14.3), C-reactive protein — 77.5 mg/L (26-159), fibrinogen — 593.5 mg/ml (500—700), ferritin — 1132.6 µ/L (165-1753). The second wave of the pandemic was characterized by moderate leukocytosis (12.2·109 /L (7—19)), increase of serum fibrinogen (544 mg/ ml (405—781)), C-reactive protein (102.75 mg/L (80—163)) and ferritin (510 μg/L (230—566)). Conclusion. VTE in patients with a new coronavirus infection is followed by high mortality. In the second wave of the pandemic, mortality of patients with VTE was higher that may be associated with both thrombotic complications and cardiovascular comorbidities.