ABSTRACT
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 throm-bomodulin. 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 thrombin-emia, which, in turn, points to the effectiveness of antithrombotic prophylaxis. The appointment of high prophylactic LMWHs doses seems to be justified, effective and safe. © 2022, Hemostasis and Rheology LLC. All rights reserved.
ABSTRACT
Background : COVID-19 demonstrates a high mortality because of rapidly progress to severe and critical cases with respiratory distress syndrome, coagulation dysfunction, multiple organ failure, etc. Therefore, early identification of the disease expansion is very important to the clinical diagnosis and treatment of COVID-19. Aims : The aim of our study was to investigate the value of some coagulation parameters -prothrombin test (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), D-dimer (DD), factor VIII activity (FVIII), ristocetin-cofactor von Willebrand's factor activity (vWF:RCo), von Willebrand's factor antigen (vWF:Ag), antithrombin (AT) and homocysteine (HCY) -in predicting of prognosis of COVID-19. Methods : These laboratory data were collected at hospitalization in 104 patients with COVID-19. Outcomes were divided into two types: hospital discharge ( n = 81) and death ( n = 23). Statistical analysis was performed by non-parametric methods (median (Me), 95% confidence interval (95% CI) and Mann-Whitney U test, Statistica 12.0), P < 0.05 was considered statistically significant. Results : Coagulation profiles observed in both groups of patients reflect a hypercoagulability, but PT and AT were significantly lower, while DD and HCY levels -significantly higher in patients with poor prognosis, and no difference in the other parameters was observed (data shown in the table). Conclusions : The results of this study showed that hypercoagulation was present in patients with COVID-19. Severe coagulation dysfunction is more likely to occur in critically ill patients. PT, AT, DD and HCY could serve as diagnostic indicators for disease outcome.
ABSTRACT
Background : COVID-19 course is characterized of thrombosis complications, respiratory failure, and a multiple organ failure development. One of the central pathogenic mechanism of COVID-19 is endothelial dysfunction which can lead to the hypercoagulability. Studying of the endothelial dysfunction markers in patients with COVID-19 could be useful for improving of disease's outcomes. Aims : To estimate potential endothelial damage in COVID-19 patients by measuring biomarkers of endothelial disfunction. Methods : The study included 221 patients with COVID-19 and 68 healthy controls. We studied ristocetin-cofactor von Willebrand's factor activity (vWF:RCo, %), antigen von Willebrand's factor (vWF:Ag,%), and homocysteine (HCY, μmol/l) . STATISTICA 12.0 package was used. Statistical analysis was performed by non-parametric methods (median (Me), 95% confidence interval (95% CI), Mann-Whitney U test), P < 0.05 was considered statistically significant. Results : Conclusions : The increase of vWF:RCo activity, vWF:Ag and HCY may indicate endothelial damage in COVID-19 patients that can lead to hypercoagulability and predispose to thromboembolic complications. High vWF:Ag could be predictive marker of poor outcomes in COVID-19 patients.
ABSTRACT
Background : The concept of immunothrombosis has established as a central pathogenic factor leading to thrombosis complications, respiratory failure, and a multiple organ failure in patents with COVID-19. Studying of the hypercoagulability in patients with COVID-19 could be useful for improving of disease's outcomes. Estimation of anticoagulants efficiency can be informative for thrombotic risk assessment. The highest interest presents protein C system, because, as we know, infection and inflammation lead to disfunction of this anticoagulant system. Aims : To estimate the efficiency of protein C anticoagulant system in COVID-19 patients. Methods : The study included 60 patients with COVID-19 and 21 healthy controls . Thrombin generation was assessed by CAT according to Hemker et al. Measure was conducted in platelet poor plasma with or without presence of thrombomodulin. The following parameters were determined: endogenous thrombin potential (ETP, nM∗min), peak thrombin (Peak, nM). Sensitivity ETP and Peak for thrombomodulin were calculated as percent of decreasing of these parameters after adding thrombomodulin to the assay. Reduction of sensitivity for thrombomodulin indicates dysfunction of anticoagulant protein C system. Protein C activity and free protein S level were measured by 'ACL ELIT PRO', Instrumentation Laboratory, USA. STATISTICA 12.0 package was used. Results are presented as median with 95% confidence intervals, P < 0.05 was considered statistically significant (∗). Results : Sensitivity ETP and Peak for thrombomodulin, protein C activity and free protein S level are presented in the table. Conclusions : The efficiency of protein C anticoagulant system is depressed in COVID-19 patients. It may be associate with protein S level decreasing. The disability of anticoagulant protein C system can lead to hypercoagulability and it may be cause of thrombotic complication.