The role of anticoagulation in preventing myocardial infarction and improving the outcomes among covid-19 patients

ABSTRACT

COVID-19 has been associated with various cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is severe in patients with pre-existing cardiovascular disease, and in these cases the systemic inflammatory response due to a cytokine storm can lead to acute myocardial infarction. Hypercoagulation in COVID-19 can also predispose patients to fatal vascular events. Furthermore, these patients also have high hematocrit and platelet values, which, in their turn, contribute to the high risk of vascular events. We hypothesize that the use of anticoagulants and antiplatelets is decisive for prevention of acute coronary syndromes, especially in patients with pre-existing cardiovascular diseases. Prospective cohort study was conducted in patients with confirmed diagnosis of COVID-19 admitted to National Center for Infectious Diseases Ministry of Health of the Republic of Armenia. Clinical, laboratory data, total and cardiovascular mortality, the incidence of a myocardial infarction and treatment regimens were compared in two groups according to the time of the hospitalization 40-day period in April-May (I Group) and October-November (II Group). Totally195 patients were enrolled in the study, which were divided into two groups. In I Group there were 93 patients with 36,5% of pre-existing cardiovascular diseases, in II Group 102 patients with 38,2% of pre-existing cardiovascular diseases. There was also drastic difference in laboratory test results between two groups. I Group was managed with minimal infusion therapy and only 10,7% received anticoagulation. In contrast, II Group was receiving preventive doses of anticoagulants and antiplatelet, and proper infusion therapy was administered. In I Group 7 cases of myocardial infarction were recorded, while patients in II Group, only 3 cases (1 of them with previous 1 of them with previous myocardial infarction). Statistical analysis revealed no significant difference in overall mortality (4.3% vs 6.86%, p = 0.441) and myocardial infarction incidence (7.5% vs 2.9%, p = 0.149) between two groups. In contrast there was significant difference in the incidence of severe and critically ill cases between two groups (69.9% and 7.5% vs 75.5% and 20.6%, p < .001).