Aggregogram changes in COVID-19 patients treated by clopidogrel and aspirin

Abstract

Background. Pathophysiological processes in lungs in COVID-19 have some similarities with macrophage activation syndrome, disseminated intravascular coagulation, which occur in other diseases and correspond to modern paradigm of “thrombosis”. Antiaggregants can influence the COVID-19 as contributing factors in reducing the level of “thrombosis” and preventing platelet aggregation. It is possible to assess the role of platelet aggregation in COVID-19 using aggregograms. The purpose of the study is to compare the aggregograms of patients without antiaggregant and those receiving standard-dose antiaggregant at COVID-19. Materials and methods. The study included 55 patients aged 41 to 75 years (mean age 63.9±1.3 years). There were 32 men and 23 women. The patients were divided into 2 groups according to the pattern of anti-aggregates use in the intensive care protocol: Group 1 (26 patients) - patients who did not take antiplatelet agents before COVID-19, but started for thromboprophylaxis as prescribed by a doctor in the intensive care unit. Group 2 (29 patients) - patients who had not taken antiplatelet agents before COVID-19 and did not take them during COVID-19 treatment in the ICU. Results. Analyzing the platelet aggregation indices of patients in groups 1 and 2, both groups of patients have a tendency to an increased rate of platelet aggregation by the inducer ADP at 0,5; 1.0;2.0 mmol/l compared with normal reference values. Conclusions. The above indicates the development of platelet hyperaggregation with vasculitis in both groups, which is characteristic of the systemic inflammatory response syndrome in COVID-19 and supports the “thrombosis” theory. The average increase in aggregation was no more than 20% of the reference values. In the treatment of group 1 patients on the 5th day, positive dynamics in the reduction of platelet aggregation capacity was observed when platelets were incubated with ADP at dilutions of 0.5; 1.0 and 2.0 mmol/l, respectively. This indicated a decrease in platelet aggregation capacity, which is undoubtedly an additional factor in reducing the risk of thrombosis.

Keywords

• covid-19
• aggregogram
• intensive care
• antiaggregants
• “thrombosis” theory