Abstract
Coagulopathy and associated thrombotic complications are common conditions seen in COVID-19. Therefore, anticoagulants are an integral part of the treatment of patients with COVID-19.The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19.Materials and methods. Two stages of patient management were compared: before and after the start of a widespread use of oral anticoagulants (OAC). The incidence of pulmonary embolism and gastrointestinal bleeding during the compared time periods was analyzed to assess the efficacy and safety of anticoagulants. To assess the cost-effectiveness, we compared the cost of anticoagulants per day of treatment and per patient.Results. The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods. Despite the increased frequency of anticoagulant use, the costs per day of treatment and per patient decreased after the start of a widespread use of OACs.Conclusion. According to the results of the study, inclusion of OACs in COVID-19 management protocols allows to reduce treatment costs without compromising its efficacy and safety. However, the short period of comparison does not allow drawing any firm conclusions. Additional large-scale comparative studies are needed.
Highlights
Одним из грозных осложнений новой коронавирусной инфекции является коагулопатия и сопряженные с ней тромботические осложнения [1, 2]
The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19
The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods
Summary
Одним из грозных осложнений новой коронавирусной инфекции является коагулопатия и сопряженные с ней тромботические осложнения [1, 2]. В связи с этим адекватное применение антикоагулянтов становится неотъемлемой частью терапии пациентов с COVID-19, что нашло отражение в рекомендациях по лечению COVID-19, в том числе и во временных методических рекомендациях Министерства здравоохранения Российской Федерации по профилактике, диагностике и лечению новой коронавирусной инфекции. В такой ситуации затраты на приобретение антикоагулянтов составляют значимую долю от общих затрат на медикаменты в стационарах, оказывающих медицинскую помощь пациентам с COVID-19. Замена НМГ оральными антикоагулянтами (ОАК) позволила бы снизить затраты медицинских организаций. Согласно последним версиям временных методических рекомендаций Министерства здравоохранения Российской Федерации по профилактике, диагностике и лечению новой коронавирусной инфекции, ОАК вошли в схемы лечения пациентов с высоким риском тромбообразования на амбулаторном этапе [7, 8]
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