ПОКАЗАТЕЛИ КОАГУЛЯЦИОННОГО РАВНОВЕСИЯ И АГРЕГАЦИИ ТРОМБОЦИТОВ У ПАЦИЕНТОВ С ИНФЕКЦИЕЙ COVID-19

Abstract

Objective. To determine changes in coagulation balance and platelet aggregation in patient during the treatment of COVID-19 infection. Methods. A pilot non-randomized prospective clinical study of coagulation balance and platelet aggregation in patients admitted to the intensive care unit with acute respiratory distress syndrome and the diagnosis of COVID-19 (n=50) was performed. Out of 50 patients, 19 patients died, 31 patients were transferred to the therapeutic department. The study of indicators of coagulation balance and platelet aggregation was carried out once in 1-3 days starting from the patient’s admission to the hospital using coagulation analyzer ACL 10000 (Instrumentation Laboratory, USA) and platelet aggregation analyzer AP 2110 (ZAO “SOLAR”, Republic of Belarus). Results. In 45 (90%) patients with COVID-19, there is a significant increase of von Willebrand factor activity 350 (244.5; 480) %. There were no statistically significant differences in the level of von Willebrand factor activity among the deceased and surviving patients: 450.0 (338.8; 530.5) % in deceased patients and 342.0 (188.8; 480.0) % in survivors. At von Willebrand factor activity level of up to 250%, the mortality rate was 8.3%, at a level of 250-400% - 31.3%, at a level of more than 400% - 59.1%. Significantly above the normal range in most patients were fibrinogen (above normal in 68% of patients, 4.63 (3.49; 5.87) g/L) and D-dimers (above normal in 88% of patients, 0.73 (0,31; 1.4) μg/ml). Antithrombin III was below normal in 56% of patients (82 (67.1; 97.2) %). The degree of platelet aggregation has a strong direct correlation with the von Willebrand factor level: with an ADP inducer 0.3 μg/ml (R=0.71, р=0.003); ADP 0.6 μg/ml (R=0.74, р=0.0001); ADP 1.25 μg/ml (R=0.53, р=0.01). Conclusion. Analysis and evaluation of coagulation balance and platelet aggregation should be an integral part in the treatment of patients with COVID-19 infection. What this paper adds For the first time, the indicators of coagulation balance and platelet aggregation have been assessed in the treatment of COVID-19 infection. It has been found that 90% of patients had the increasedlevels ofvon Willebrand factor(VWF) - 350 (244.5; 480)%. In addition to an increase of von Willebrand factor activity, 56% of patients show a reduction of antithrombin III levels, and 88% and 68% of patients have an increasing D-dimers and fibrinogen, respectively. Analysis and assessment of coagulation balance and platelet aggregation indicators should be integral components of the treatment of patients with COVID-19 infection.