Медицина неотложных состояний (Jun 2023)

Studying the effectiveness of varieties of anticoagulant therapy programs in patients with a severe course of COVID-19 (analysis of own clinical observations)

  • O.M. Mazur,
  • M.V. Bondar

DOI
https://doi.org/10.22141/2224-0586.19.3.2023.1576
Journal volume & issue
Vol. 19, no. 3
pp. 162 – 168

Abstract

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Background. Currently, there is no internationally approved protocol for anticoagulant therapy (ACT) in patients with COVID-19 that describes the different types of ACT programs depending on the severity of COVID-19. The objective: to determine optimal ACT programs. Materials and methods. A retrospective ana­lysis of ACT programs was conducted in 268 patients with extremely severe COVID-19 who were treated in the intensive care units. Results. The article presents the results of retrospective analysis of ACT programs in 268 patients with a very severe course of COVID-19 treated in the general intensive care unit in 2021. ACT programs in 162 patients who died because of COVID-19 and in 106 survived patients were studied separately. The total duration of hospital stay was from 9 to 55 days. ACT programs were mostly in line with Euro­pean guidelines/instructions. ACT included a stepwise combination of unfractionated heparin, low-molecular-weight heparins, and oral anticoagulants depending on the clinical course, concomitant pathology, and laboratory parameters. The systemic inflammatory response was characterized by the concentration of C-reactive protein in the blood plasma within the range of 54.7–331.4 mg/l (on average 95.4 ± 73.4 mg/ml), ferritin of 208–2094 μg/l (on average 947.16 ± 872.00 μg/l), interleukin-6 of 33.9–507.4 pg/ml (on average 152.60 ± 201.15 pg/ml). The level of D-dimer in blood plasma ranged from 3.74 to 82.0 μg/ml (on average 8.200 ± 3.525 μg/ml). Platelet content in peripheral blood ranged from 372 × 109/l to 72 × 109/l. Conclusions. The optimal ACT program in patients with severe and extremely severe COVID-19 is a program of sequential change of anticoagulant drugs to enhance their anticoagulant effect, which can be controlled by laboratory tests.

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