Hemostasis correction in the treatment and rehabilitation of COVID-19 patients

Abstract

Background. It is well known that the severe course of a new coronavirus infection (NCI) is often accompanied by a significant risk of hemostasis system disorders. Virus-associated coagulopathy in COVID-19 differs from its other types. Apparently, it is directly related to inflammatory processes and an inadequate response from the immune system.Objective: to determine the main mechanisms of immune-mediated coagulopathy development in NCI patients and methods of correcting this pathological condition.Material and methods. The search for studies devoted to the specifics of coagulopathy course in COVID-19, treatment and rehabilitation of patients with this complication was carried out in international scientific research databases PubMed/ MEDLINE, Google Scholar, ScienceDirect and scientific electronic library (eLibrary). The search depth was 20 years. The results of queries in search engines Yandex and Google were also taken. After selection of publications performed according to PRISMA recommendations, 73 articles were included in the review.Results. A “vicious circle” associated with cytokine storm underlies the pathogenetic mechanisms of immune-mediated thrombosis in COVID-19 patients. A significant role of endothelial dysfunction, extracellular neutrophil traps (NETs), thrombocytopathy and changes in complement system activity is assigned to coagulopathy development. The therapy of this complication is aimed primarily at pathogenetic process. The effectiveness of anticoagulants, anti-inflammatory drugs, antiplatelet agents, drugs aimed at limiting the role of NETs and complement system in thrombosis development was shown. The expediency of preventive use of anticoagulants in COVID-19 patients was considered. Information was provided on the rehabilitation of NCI patients with coagulopathy. The effectiveness of combined anti-inflammatory and anticoagulant therapy in COVID-19 as a component of complex rehabilitation was indicated.Conslusion. Inflammatory processes and immune response play an crucial role in coagulopathy development in NCI patients. The combination of all pathogenetic changes on the part of immune system, inflammatory response and hemostasis system makes it difficult to carry out therapeutic measures. The general scheme of rehabilitation for COVID-19 patients should include three stages, and timely use of combined anti-inflammatory and anticoagulant therapy is also advisable.