Heparin type influence on cellular hemostasis indicators in COVID-19-associated pneumonia


DOI: https://dx.doi.org/10.18565/therapy.2021.8.14-21

Antonov V.N., Osikov M.V., Ignatova G.L., Zotov S.O.

1) South-Ural State Medical University of the Ministry of Healthcare of Russia, Chelyabinsk; 2) Regional Clinic Hospital No. 3, Chelyabinsk; 3) Chelyabinsk Regional Clinical Hospital
Abstract. Coronavirus Disease 2019 (COVID-19) causes a hypercoagulable condition.
Objective: to evaluate the indicators of cellular hemostasis in patients with COVID-19-associated pneumonia, taking into account the severity of the disease, and to identify the effect of the anticoagulant therapy regimens used on cellular hemostasis.
Material and methods. This open-label, biphasic study examined patients with COVID-19 aged 44 to 75 years (Me 63 years (Q4 55, Q1 68)). Depending on the degree of lung damage, at the time of admission severity of disease was characterized by moderate (64% of patients) and severe (36% of patients). The blood platelet count and the induced platelet rate were assessed. The inducers used were ADP (2,5 mmol/ml), collagen (3,3 mg/ml), adrenaline (5 mg/ml) on the 1st and 8th days from the moment of hospitalization. In addition, an assessment was made of the effect of anticoagulant therapy on the studied parameters, taking into account the severity of the course of the disease. In addition to standard antiviral therapy and glucocorticoids, patients received unfractionated heparin or sodium enoxaparin.
Results. This study has demonstrated the effect of the severity of COVID-19-associated pneumonia on both the number of platelets and the rate of their aggregation. The presence of thrombocytopenia is noticeable in patients with significant (more than 50%) involvement of lung tissue in the inflammatory process. In addition, a more pronounced effect of low molecular weight heparin (in this case, sodium enoxaparin) compared with unfractionated heparin on the parameters of cellular hemostasis in patients with COVID-19-associated pneumonia was revealed. Thrombocytopenia was not detected in the groups receiving low molecular weight heparin and the induced platelet aggregation rate was lower than in the groups of unfractionated heparin.
Conclusion. In the presented work, prophylactic doses of enoxaparin sodium and unfractionated heparin have demonstrated their effect on the parameters of cellular hemostasis, which can be used in the choice of anticoagulant therapy for severe and moderately severe forms of COVID-19. It is possible to propose an addition to the sections for the prevention of thrombotic complications in the existing clinical guidelines for the management of patients with severe COVID-19-associated pneumonia, in particular, to recommend the active prescription of low weight heparin to patients with a severe course of the disease.
Keywords: SARS-CoV-2, COVID-19, platelets, hemostasis, heparin, thrombosis
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About the Autors

Vladimir N. Antonov, MD, professor of the Department of therapy of the Institute of continuing professional education, South-Ural State Medical University of the Ministry of Healthcare of Russia. Address: 454021, Chelyabinsk, 81 Ostrovskogo Str. E-mail: ant-vn@yandex.ru. ORCID: 0000-0002-3531-3491
Mikhail V. Osikov, MD, professor, head of the Department of pathological physiology, head of the Department of scientific and innovative work, South-Ural State Medical University of the Ministry of Healthcare of Russia, head of Research Department of Chelyabinsk Regional Clinical Hospital. Address: 454092, Chelyabinsk, 66/3 Vorovskogo Str. E-mail: prof.osikov@yandex.ru. ORCID: 0000-0001-6487-9083
Galina L. Ignatova, MD, professor, head of the Department of therapy of the Institute of continuing professional education, South-Ural State Medical University of the Ministry of Healthcare of Russia. Address: 454021, Chelyabinsk, 81 Ostrovskogo Str. E-mail: iglign@mail.ru. ORCID: 0000-0002-0877-6554
Semyon O. Zotov, pulmonologist of Regional Clinic Hospital No. 3 (Chelyabinsk), senior laboratory assistant of the Department of pathological physiology, South-Ural State Medical University of the Ministry of Healthcare of Russia. Address: 454021, Chelyabinsk, 81 Ostrovskogo Str. E-mail: semenz2007@yandex.ru. ORCID: 0000-0001-7469-2386


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