Analysis of Risk Factors of Venous Thromboembolic Complications and of Different Variants of Anticoagulant Therapy in Patients with New Coronavirus Infection

Abstract

INTRODUCTION: A new coronavirus infection (NCI) is characterized by catastrophic coagulopathy with development of thrombotic and hemorrhagic complications. The choice of an optimal anticoagulant in these patients remains an important issue. AIM: To evaluate risk factors for venous thromboembolic complications (VTEC), effectiveness and safety of different variants of anticoagulant therapy (ACT) in patients with NCI. MATERIALS AND METHODS: A prospective study was conducted that involved 370 patients with NCI: group 1 patients who received low molecular weight heparin (LMWH) 190 people, group 2 patients who received unfractionated heparin (UFH) 123 people, group 3 patients who took direct oral anticoagulants (DOAC) 57 individuals. Clinical and anamnestic data, frequency of thrombotic and hemorrhagic complications were evaluated. The study was approved by the Local Ethics Committee and was registered on ClinicalTrials.gov. platform. RESULTS: The existence of chronic venous diseases increases the risk of development of venous thromboembolism (VTE) in patients with NCI 6.433 times (95% confidence interval (CI) 2.16719.093)) (р = 0.001), use of UFH instead of LMWH or DOAC 3.542 times (95% CI 1.14910.916) (р = 0.028), use of artificial lung ventilation (ALV) 5.925 times (95% CI 2.03417.26) (р = 0.001), high D-dimer level 2.024 times (95% CI 1.2313.33) (р = 0.005). The level of C-reactive protein and ferritin decreased in all patients in the course of treatment for NCI, with the lowest levels in patients receiving LMWH (С-reactive protein 5.8 (1.715.0) mg/l, р = 0.004; ferritin 364 (324497) g/l, р = 0.001). Lower fibrinogen levels were recorded in patients of group 1 compared to groups 2 and 3 (2.43 (1.93.52) g/l versus 3.37 (2.84.92) g/l and 4.1 (2.85.25) g/l, respectively, р = 0.002). A high frequency of pulmonary embolism with unspecified source was recorded in patients receiving UFH 11.4% of cases, with this, the frequency of using ALV in the group with UFH was evaluated as high 21% of cases. CONCLUSION: Risk factors of VTEC in patients with NCI are both factors typical of VTEC in general (obesity, chronic vein diseases, elevated D-dimer level), and factors specific of NCI (ALV, hypoventilation). Effective and safe anticoagulants in this group of patients are LMWH that demonstrated low frequency of development of VTEC and of hemorrhagic complications.