Saratov JOURNAL of Medical and Scientific Research
Home

COVID-19-associated coagulopathy: pathogenetic features and practical aspects of diagnosis and treatment (review)

Year: 2021, volume 17 Issue: №4 Pages: 741-746
Heading: Internal Diseases Article type: Review
Authors: Yupatov V.D., Ponomareva E.Yu.
Organization: Saratov State Medical University
Summary:

Violation of hemocoagulation is an important factor that complicates the course of a new coronavirus infection (SARS-CoV-2) and largely determines the prognosis and outcome of the disease. Correction of rheological and hemo-static disorders in SARS-CoV-2 is one of the key aspects of pathogenetic therapy, which is necessary in the practice of patient management. Purpose: analyzed the data of the current literature on various aspects of thrombotic complications in SARS-CoV-2: the frequency of their development, the features of pathogenesis, clinical manifestations and approaches to the treatment of COVID-19-associated. 42 literary sources were analyzed using databases and information resources with open access: PubMed, Google Scholar, UpToDate, eLibrary; the depth of search for literary sources was 5 years. A significant increase in the concentration of D-dimer in patients with SARS-CoV-2 was established, which can serve as a predictor of death. A distinctive feature of COVID-19-associated coagulopathy is the so-called "thromboinflammation", which underlies the damage to organs and systems in a new coronavirus infection. The most significant markers of COVID-19-associated coagulopathy are the levels of D-dimer, prothrombin time, and blood fibrinogen. Prevention of thromboembolic complications is indicated in all hospitalized patients with SARS-CoV-2. For the correction of hemocoagulation disorders, the drugs of choice are low-molecular-weight heparins. The tactics of primary prevention of thromboembolic complications in hospitalized and outpatient patients require further study.

Keywords: anticoagulants, coagulopathy, COVID-19, venous thromboembolic complications

Bibliography:
1. Fried JA, Ramasubbu K, Bhatt R, et al. The variety of cardiovascular presentations of COVID-19. Circulation 2020; 141 (23): 1930-36. DOI: 10.1161/CIRCULATIONAHA.120.047164.
2. Shlyakho EV, Konradi АО, Arutyunov GP, et al. Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic. Russian Journal of Cardiology 2020; 25 (3): 129-48. DOI: 10.15829/1560-4071-2020-3-3801.
3. Guan WJ, Ni ZY, Ни Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18): 1708-20. DOI: 10.1056/NEJMoa2002032.
4. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (4): 844-7. DOI: 10.1111/jth.14768.
5. Leonard-Lorant I, Delabranche X, Severac F, et al. Acute pulmonary embolism in patients with COVID-19 at CT angiogra-phy and relationship to D-dimer levels. Radiology 2020; 296 (3): 189-91. DOI: 10.1148/radiol.2020201561.
6. Cui S, Chen S, Li X, et al. Prevalence of venous throm-boembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (6): 1421-4. DOI: 10.1111/jth. 14830.
7. Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18 (8): 1995-2002.
8. Julien P, Julien G, Morgan C, et al. Pulmonary embolism in COVID-19 patients: awareness of an increased prevalence. Circulation 2020; (142): 184-6. DOI: 10.1161/CIRCULATIONAHA. 120.047430.
9. Lobastov KV, Schastlivtsev IV, Porembskaya OYa, et al. COVID-19-associated coagulopathy: a review of current guidelines for diagnosis, treatment and prevention. Ambulatory Surgery 2020; (3-4): 36-51. DOI: 10.21518/1995-1477-2020-3-4-36-51.
10. Jimenez D, Garcia-Sanchez A, Rali Р, et al. Incidence of venous thromboembolism and bleeding among hospitalized patients with COVID-19: a systematic review and meta-anal-ysis. Chest 2020; 159 (3): 1182-96. DOI: 10.1016/j.chest. 2020.11.005.
11. Gu SX, Tyagi T, Jain K, et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 throm-boinflammation. Nat Rev Cardiol 2021; (18): 194-209. DOI: 10.1038/S41569-020-00469-1.
12. Tang W, Stitham J, Jin Y, et al. Aldose Reductase — Mediated Phosphorylation of p53 Leads to Mitochondrial Dysfunction and Damage in Diabetic Platelets. Circulation 2014; 129 (15): 1598-1609. DOI: 10.1161/CIRCULATIONAHA.113.005224.
13. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020; 5 (7): 811-818. DOI: 10.1001 /jamacardio.2020.1017.
14. Mehra MR, Desai SS, Kuy S, et al. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med 2020; 382 (25): e102. DOI: 10.1056/NEJMoa2007621.
15. Leslie, M. Cell biology. Beyond clotting: the powers of platelets. Science 2010; (328): 562-4. DOI: 10.1126/science. 328.5978.562.
16. Manne BK, Denorme F, Middleton EA, et al. Platelet gene expression and function in COVID-19 patients. Blood 2020; (136): 1317-29. DOI: 10.1182/blood.2020007214.
17. Teuwen LA, Geldhof V, Pasut A, et al. COVID-19: the vasculature unleashed. Nat Rev Immunol 2020; (20): 389-91. DOI: 10.1038/S41577-020-0343-0.
18. Xiang Y, Hwa J. Regulation of VWF expression, and secretion in health and disease. Current opinion in hematology 2016; 23 (3): 288-93. DOI: 10.1097/MOH.0000000000000230.
19. Goshua G, Pine AB, Meizlish ML, et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. The Lancet Haematology 2020; 7(8): e575-e582. DOI: 10.1016/S2352-3026(20)30216-7.
20. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogen-esis in Covid-19. N Engl J Med 2020; 383 (2): 120-8. DOI: 10.1056/NEJMoa2015432.
21. Ciceri F, Beretta L, Scandroglio AM, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis. Critical Care and Resuscitation 2020; 22 (2): 95-7. DOI: 10.3316/informit.196503333515429.
22. Vinayagam S, Sattu K. SARS-CoV-2 and coagulation disorders in different organs. Life Sci 2020; (260): 118431. DOI: 10.1016/j.lfs.2020.118431.
23. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135 (23): 2033-40. DOI: 10.1182/blood.2020006000.
24. Galstyan GM. Coagulopathy in COVID-19. Pulmonologi-ya 2020; 30 (5): 645-57. DOI: 10.18093/0869-0189-2020-30-5-645-657.
25. Temporary methodological recommendations of the Ministry of Health of the Russian Federation. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 13 (14.10.2021). URL: https://static-0.minzdrav.gov.ru/sys-tem/attachments/attaches/000/058/211 /original/BMP-13. pdf (10 Dec 2021).
26. Bikdeli В, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75 (23): 2950-73. DOI: 10.1016/j.jacc.2020.04.031.
27. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020; 18(5): 1023-6. DOI: 10.1111/jth.14810.
28. Arutyunov GP, Koziolova NA, Tarlovskaya El, et al. The Agreed Experts' Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange. Cardiology 2020; 60 (5): 9-19.
29. Bikdeli В, Madhavan MV, Gupta A, et al. Pharmacological agents targeting thromboinflammation in COVID-19: review and implications for future research. Thromb Haemost 2020; 120 (7): 1004-24. DOI: 10.1055/S-0040-1713152.
30. Viecca M, Radovanovic D, Forleo GB, et al. Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study. Pharmacological research 2020; (158): 104950.
31. Thachil J. The versatile heparin in COVID-19. J Thromb Haemost 2020; 18(5): 1020-2. DOI: 10.1111/jth.14821.
32. CukerA, Tseng EK, Nieuwlaat R, etal. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood advances 2021; 5 (3): 872-88. DOI: 10.1182/bloodadvances.2020003763.
33. ATTACC, ACTIV-4a & REMAP-CAP multiplatform RCT Results of interim analysis. January 28, 2021. URL: https://www.icna rc.org/DataServices/Attachments/Download/1 b4fc749-a567-eb11-912e-00505601089b (25 March 2021).
34. COVID-19 Anticoagulation Trials 'Paused' for Futility Safety. URL: https://www.medscape.com/viewarticle/943085 (25 March 2021).
35. Sadeghipour P, Talasaz AH, Rashidi F, et al. Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial. JAMA 2021. DOI: 10.1001/jama.2021.4152.
36. Cohoon KP, De Sanctis Y, Haskell L, et al. Rivaroxaban for thromboprophylaxis among patients recently hospitalized for acute infectious diseases: a subgroup analysis of the MAGELLAN study. J Thromb Haemost 2018; (16): 1278-87. DOI: 10.1111/jth.14146.
37. Carrier M, Abou-Nassar K, Mallick R, et al. Apixaban to prevent venous thromboembolism in patients with cancer. N Engl JMed2019; (380): 711-9. DOI: 10.1056/NEJMoa1814468.
38. Testa S, Prandoni P, Paoletti O, et al. Direct oral anticoagulant plasma levels' striking increase in severe COVID-19 respiratory syndrome patients treated with antiviral agents: The Cremona experience. J Thromb Haemost 2020; (18): 1320-3. DOI: 10.1111/jth.14871.
39. Spyropoulos AC, Lipardi C, Xu J, et al. Improved benefit risk profile of rivaroxaban in a subpopulation of the MAGELLAN study. Clin Appl Thromb Hemost 2019; (25): 1076029619886022. DOI: 10.1177/1076029619886022. 40. Bhatt VR, Aryal MR, Shrestha R, et al. Fondaparinux-associated heparin-induced thrombocytopenia. Eur J Haematol 2013; 91 (5): 437-41. DOI: 10.1111/ejh.12179.
41. Strokov AG, Poz YL. Clotting prevention in renal replacement therapy: classical approaches and new opportunities. Russian Journal of Transplantology and Artificial Organs 2010; 12 (4): 80-5. DOI: 10.15825/1995-1191-2010-4-80-85.
42. RismanbafA. Potential Treatments for COVID-19; a Narrative Literature Review. Arch Acad Emerg Med 2020; 8 (1): e29.

AttachmentSize
2021_04_741-746.pdf347.8 KB
All articles of the authors: Ponomareva E.Yu., Yupatov V.D.

No votes yet