COVID-19: step-by-step treatment strategies

Abstract

Objective: to evaluate the effectiveness and safety of anticoagulant and glucocorticosteroid therapy in patients with COVID-19, to determine step-by-step solutions in the prescription of drug therapy at the inpatient stage.Materials and methods. We performed two randomized continuous prospective comparative studies including 1,801 patients diagnosed with COVID-19 pneumonia who were undergoing inpatient treatment in November-December 2020 (1,004 patients) in Gomel Regional Clinical Hospital for the Disabled of World War II and in February 2021 (797 patients) in Gomel City Clinical Hospital No. 3.Results. The step-by-step strategy for treating patients with pneumonia associated with COVID-19 is to divide the patients into groups of high and moderate risks of adverse outcomes (based on the developed predictors) on the first day of hospitalization. In moderate-risk patients, the “protocol” therapy stabilizes the condition; in high-risk patients, it is not effective. Early preemptive anticoagulant therapy (ACT) and individual hormone therapy (prior to pulse therapy) may stabilize the condition of the patients, increase the survival rate from 82.1 % to 96.8 %, p = 0.0001. The additional steps are: targeted use of tocilizumab in the Somatic Department before the Intensive Care Department (70 % survival, p = 0.031), oxygen therapy, pronposition, catheterization of patients, use of the domestic hepatoprotector, membrane-stabilizing antiischemic drug “Thiotriazoline” in patients with high blood lactate levels (lactate dehydrogenase (LDH)), which stabilizes metabolic processes in the affected organs (in dynamics by 342.7 ± 92.8 units/l for 5 days compared to the control group, p=0.0001). When the patient’s condition gets stabilized, the use of respiratory and physical rehabilitation are the final steps of the recovery strategy at the inpatient stage.Conclusion. Therapeutic anticoagulant and individual glucocorticosteroid therapy in combination with oxygen therapy, the use of thiotriazoline in some COVID-19 patients being at a high risk of adverse outcomes have led to an increased survival rate — from 82.1 % to 96.8 % at the hospital stage, p = 0.0001.