ABSTRACT
Introduction. Currently used and available in real clinical practice, laboratory tests do not allow an objective and reliable assessment of risk and severity of thrombinemia, prothrombotic readiness, and, as a result, does not allow to choose the appropriate optimal antithrombotic therapy regimen (administration of prophylactic or therapeutic anticoagulant doses) in relation to the screening of this condition in severe COVID-19. Objective: analysis of prothrombotic readiness in COVID-19-patients by integral method — thrombin generation (kinetics) assay. Materials and Methods. A prospective clinical and laboratory study included 100 patients (average age was 63 [31–85] years, 60 women, 40 men) with an identified SARS-CoV-2 virus with moderate and severe course of novel coronovirus infection. Parameters of thrombin generation (kinetics) assay — clotting initiation time (tLag), time of thrombin peak formation (tPeak), thrombin peak (Peak), endogenous thrombin potential (ETR;area under the thrombin formation curve, AUC) were determined, as well as levels of fibrinogen, D-dimer, ferritin, C-reactive protein (CRP), activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR). Results. The results of thrombin kinetics assay pointed to an increased blood procoagulant potential in COVID-19-patients on admission to the hospital;correlations were found between tLag and fibrinogen (rS = –0.7;p = 0.001), tLag and CRP (rS = –0.1;p = 0.01);between tPeak and all inflammation markers — D-dimer (rS = –0.4;p = 0.001), ferritin (rS = –0.2;p = 0.01), CRP (rS = –0.3;p = 0.05), fibrinogen (rS = –0.5;p = 0.001);between Peak and fibrinogen (rS = 0.3;p = 0.001);between rate index (VI) and fibrinogen (rS = 0.2;p < 0.001);between AUC and fibrinogen (rS = 0.4;p = 0.001), AUC and CRP (rS = 0.1;p = 0.001). Conclusion. Thrombin generation (kinetics) assay can be considered as a marker of thrombinemia — prothrombotic readiness in patients with moderate and severe course of novel coronovirus infection. © 2023, Hemostasis and Rheology LLC. All rights reserved.
ABSTRACT
Background: TGA is a sensitive and specific method for diagnosing thrombin formation and one of the best methods correlating with bleeding or thrombotic events. TGA provides information about the total clotting potential, because thrombin generation does not stop after the formation of fibrin clots. Aim(s): To evaluate the parameters of the thrombin generation test in patients with Covid-19. Method(s): A retrospective study on the basis of the regional center for antithrombotic therapy of SBHI CCH 1 City Hospital named after E.E.Volosevich . Patients with confirmed Covid-19 (n = 100). Blood sampling to determine the parameters of the thrombin generation (kinetics) test (TGA) was performed on the 1st day of the study. The automatic formulation of the TGA method is carried out on an open-type coagulometer Ceveron alpha TGA. Genetic methods -Real- time PCR, Litech Company (Russia): Hemostasis system genes: FII G20210A, FGB G455A, PAI-1675 5G/4G. Result(s): It was found that Tlag (min) and tPeak (min) significantly decreased in patients on the 1st day of hospitalization. Correlation analysis of Tlag (min) with the genotype of F I (fibrinogen) rS = - 0.3 (p = 0.02), confirming that heterozygous polymorphism of the FI gene is associated with a decrease in Tlag (min). The presence of polymorphism in the PAI-1 gene is associated with a decrease in tPeak (min), i.e. in patients with polymorphism in PAI-1, the peak of thrombin is achieved faster (rS = 0.5;p = 0.03). The presence of polymorphism in the F I gene is associated with an increase in Peak (nmol/l), which is significantly higher in contrast to patients without polymorphism. The presence of polymorphisms in the PAI-1 and F I genes is associated with an increase in EPT (nmol/min: RS = 0.3;p = 0.04 and rS = 0.6;p = 0.02). Conclusion(s): The results of TGA in our study reflect data on an increase in the procoagulant potential of blood in patients with COVID-19.
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Background: Currently, the prothrombogenic status in Covid-19 infection and the possible influence of genetic polymorphism of the hemostasis system are widely discussed. Aim(s): The aim of the study was to evaluate the molecular and genetic features of the hemostasis system in patients with Covid-19 Methods: The study was performed on the basis of the regional center for antithrombotic therapy Arkhangelsk.A molecular genetic analysis was performed for the presence of prothrombogenic mutations in patients (n = 100) with Covid-19 in a covid hospital. Result(s): Polymorphism in the F I G/A-455 (fibrinogen) gene was found in 43% of patients (homozygote -6%, heterozygote -37%), polymorphism in the ITG B3 1565 T>C gene -in 38% (26% -heterozygous carrier and 12% -homozygous). In our study, a mutation in the prothrombin F II gene G20210-A (heterozygous allelic variant -2%) and a "true" prothrombogenic mutation of factor V (Leid) were found with the lowest (6% -heterozygous state). Next, we analyzed the dependence of genetic polymorphism of hemostasis system factors F II 20210 G>A, F V 1691 G>A, PAI-1 675 5G>4G and thrombinemia levels in patients with COVID-19. The level of fibrinogen (>6.0 g/l;p < 0.05) was statistically significantly higher in the groups of patients with prothrombogenic polymorphism in the genes of coagulation factor V (F V), coagulation factor II (F II), PAI-1 for the entire period of hospitalization. Upon admission, the levels of D-dimer and fibrinogen were statistically significantly higher in patients with a mutation in the F II gene. Conclusion(s): When treating Covid-19, it is advisable to take into account the presence of molecular genetic markers of prothrombogenic status in a patient.
ABSTRACT
Background : COVID-19 in hospital in Arkhangelsk. Aims : The goal is to assess clinical and laboratory signs in moderately severe patients with COVID-19. Methods : The study included patients hospitalized for COVID-19 -109 patients. On admission to the hospital, some clinical symptoms were assessed;CRP, LDH, ferritin, APTT, D-dimer, fibrinogen indicators and complete blood count (leukocyte, lymphocyte, platelet count. Results : The average age of patients was Me [Q1-Q3] 62 [34-71] years. Upon admission to the hospital, a positive smear by the polymerase chain reaction method for the presence of coronavirus infection was determined in 60% ( n = 66) of patients. Fever was reported in 60% ( n = 65), in 15% of cases, patients described chest pain ( n = 16), 44% of patients complained of shortness of breath ( n = 49), 71% ( n = 77) of patients complained of cough, sore throat and lack of sense of smell were observed in 4.6% ( n = 5). In the coagulogram, all patients showed an increased level of D-dimer -4 [0.5-8.0] mg / L, the level of fibrinogen -4 [2.6-7.5] g/L, APTT 41, 6 [24-54] s, There was a normal level of prothrombin time -12 [10-17] s. The average level of leukocytes was 8.2 [3.8-10.5] ∗ 109 / l, lymphocytes -30 [26-57] %, platelets -223 [170-339] ∗ 109 / l, ESR -30.9 [ 10-47.5] mm / h. The values of biochemical parameters -markers of inflammation were also above the reference range: CRP -50.4 [0.4-237] mg / L, ferritin -563 μg /L, LDH -638 [100-760] U / L. Conclusions : In the initial period of the development of COVID-19 there was an increased level of thrombinemia, which indicated the presence of a risk of thromboembolic complications, but there was a tendency towards an increase in APTT.