Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors.

Introduction: Cardiovascular events are common in COVID-19. While the use of anticoagulation during hospitalization has been established in current guidelines, recommendations regarding antithrombotic therapy in the post-discharge period are conflicting. Methods: To investigate this issue, we conducted a retrospective follow-up (393 ± 87 days) of 1,746 consecutive patients, hospitalized with and surviving COVID-19 pneumonia at a single tertiary medical center between April and December 2020. Survivors received either 30-day post-discharge antithrombotic treatment regime using prophylactic direct oral anticoagulation (DOAC; n = 1,002) or dipyridamole (n = 304), or, no post-discharge antithrombotic treatment (Ctrl; n = 440). All-cause mortality, as well as cardiovascular mortality (CVM) and further cardiovascular outcomes (CVO) resulting in hospitalization due to pulmonary embolism (PE), myocardial infarction (MI) and stroke were investigated during the follow-up period. Results: While no major bleeding events occured during follow-up in the treatment groups, Ctrl showed a high but evenly distributed rate all-cause mortality. All-cause mortality (CVM) was attenuated by prophylactic DOAC (0.6%, P < 0.001) and dipyridamole (0.7%, P < 0.001). This effect was also evident for both therapies after propensity score analyses using weighted binary logistic regression [DOAC: B = -3.33 (0.60), P < 0.001 and dipyridamole: B = -3.04 (0.76), P < 0.001]. While both treatment groups displayed a reduced rate of CVM [DOAC: B = -2.69 (0.74), P < 0.001 and dipyridamole: B = -17.95 (0.37), P < 0.001], the effect in the DOAC group was driven by reduction of both PE [B-3.12 (1.42), P = 0.012] and stroke [B = -3.08 (1.23), P = 0.028]. Dipyridamole significantly reduced rates of PE alone [B = -17.05 (1.01), P < 0.001]. Conclusion: Late cardiovascular events and all-cause mortality were high in the year following hospitalization for COVID-19. Application of prophylactic DOAC or dipyridamole in the early post-discharge period improved mid- and long-term CVO and all-cause mortality in COVID-19 survivors.

Correlation of the Imbalance in the Circulating Lymphocyte Subsets With C-Reactive Protein and Cardio-Metabolic Conditions in Patients With COVID-19.

The immune system is severely compromised in patients with COVID-19. The representative group of 43 patients were selected from the cohort of 342 patients with COVID-19 and pneumonia. This group of 43 patients was examined for the levels of C-reactive protein, biomarker of systemic inflammation, and for the subsets of adaptive immune cells. The immunological parameters were correlated with the metabolic parameters and cardiovascular pathology history. We identified that a decrease in the absolute number of T-lymphocytes, T-cytotoxic, T-activated and B-lymphocytes correlated with the higher levels of CRP. The absolute number of T-helpers and the absolute number of double positive T-lymphocytes positively correlated with the levels of iron in serum (Z= 0,310 and Z=0,394). The absolute numbers of T-activated lymphocytes positively correlated with serum levels of LDH (Z = 0,422), ferritin (Z = 0,407) and iron (Z = 0,418). When studying subpopulations of lymphocytes, depending on the combined pathology, we found that the absolute numbers of B-lymphocytes and double positive T-lymphocytes in the peripheral blood were significantly reduced in patients with arterial hypertension (p=0,0074 and p=0,0227, correspondingly). The increased levels of NK cell were found in patients with a history of coronary heart disease (p=0,0108). In addition, we found that deficiencies in the adaptive immune system correlated with the deficiencies in iron metabolism. The cardiovascular pathology upsets the balance in the adaptive and innate immune system in the circulation of patient with severe COVID-19.

Incidence of depressive and anxiety disorders in COVID-19 patients

The aim of this study is to analyze the occurrence of depressive and anxiety disorders in patients with COVID-19 and to study the relationship of these disorders with organic damage to the central nervous system. Material and methods. An analysis of occurrence of depressive and anxiety disorders in patients with COVID-19 was carried out at the infectious hospital of the KBGMU for the period June-August 2020. Depression and anxiety were identified using the Hospital Anxiety and Depression Scale (HADS) and compared with the MRI data of the brain. Statistical data processing was carried out using Microsoft Excel 7.0. Results. According to the analysis, out of 76 patients with COVID-19, depressive disorders were observed in 36 (46.3%) patients, anxiety disorders - subclinical anxiety in 16 (21.05%), clinical anxiety - in 19 (25%). The absence of depressive disorders was observed in 40 (52.63%), the absence of anxiety - in 41 (53.94%). By gender differentiation of patients, depressive disorders in men - 20 (46.5%), women - 16 (48.48%). Anxiety disorders: subclinical anxiety in men - 11 (25.5%), women - 5 (15.15 %), clinical anxiety in men - 7 (16.2%), women - 12 (36.36%). The average age of patients at the time of the study was 45.7 years. When conducting MRI of brain, organic lesions were detected in 12 (16%) people, in 64 (84%) at the time of the study, organic lesions were not detected. When collecting a follow-up in 31 patients, depressive disorders were noted in 8 (25.8%), subclinical anxiety - 2 (6.45%), clinical anxiety - 2 (6.45%), no anxiety - 27 (87.09%), no depression - 23 (74.19%). No organic lesions were found at the time of MRI of brain. Conclusion. When studying the occurrence of depressive and anxious states and their organic substrates, we found that there is no clear relationship between them and rather have a functional character. Цель настоящего исследования - анализ возникновения депрессивных и тревожных расстройств у пациентов с COVID-19 и изучение взаимосвязи данных нарушений с органическим поражением центральной нервной системы. Материал и методы. Проведён анализ возникновения депрессивных и тревожных расстройств у пациентов с COVID-19 на базе инфекционного госпиталя клиники Башкирского государственного медицинского университета за период июнь-август 2020 г. Выявление депрессивного и тревожного состояний было проведено с помощью Госпитальной шкалы тревоги и депрессии (HADS) и сопоставлены с данными магнитно-резонансной томографии (МРТ) головного мозга. Статистическая обработка данных проведена с использованием Microsoft Excel 7,0. Результаты. По данным проведённого анализа из 76 пациентов с COVID-19 депрессивные расстройства выявлены у 36 (46,3%) пациентов, тревожные расстройства в виде субклинической тревоги - у 16 (21,05%), клинической тревоги - у 19 (25%). Отсутствие депрессивных расстройств зарегистрировано у 40 (52,63%) человек, отсутствие тревоги - у 41 (53,94%). По гендерной дифференцировке пациентов: депрессивные расстройства у мужчин - 20 (46,5%), у женщин - 16 (48,48%).Тревожные расстройства: субклиническая тревога у мужчин - 11 (25,5%), у женщин - 5 (15,15%);клиническая тревога у мужчин - 7 (16,2%), у женщин - 12 (36,36%). Средний возраст пациентов на момент проведения исследования составлял 45,7 года. При проведении МРТ головного мозга органические поражения были выявлены у 12 (16%) человек, у 64 (84%) на момент проведения исследования органических поражений не было. При сборе катамнеза из 31 пациента депрессивные расстройства отмечены у 8 (25,8%), субклиническая тревога - у 2 (6,45%), клиническая тревога - у 2 (6,45%), отсутствие тревоги - у 27 (87,09%), нет депрессии - у 23 (74,19%). На момент проведения МРТ головного мозга органических поражений выявлено не было. Вывод. При изучении возникновения депрессивных и тревожных состояний и их органического субстрата нами было установлено, что чёткая взаимосвязь между ними отсутствует;скорее эти состояния имеют функциональный характер.