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Tromboz, Gemostaz i Reologiya ; 2022(4):64-74, 2022.
Article in Russian | Scopus | ID: covidwho-2265271


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.