INFLUENCE OF DIFFERENT THROMBOPROPHYLAXIS REGIMENS WITH ENOXAPARIN ON THE COURSE AND OUTCOMES IN PATIENTS WITH SEVERE CORONAVIRUS DISEASE

Abstract

Disorders of the hemostasis system play one of the key roles in the mechanism of pathogenesis of coronavirus disease. The prevalence of thromboembolic complications in patients with severe COVID-19 reaches 20–30%. Key guidelines provide guidance on the need for prophylactic doses of enoxaparin. However, the results of intensive care remain unsatisfactory and the search for the optimal dosing regimen of enoxaparin continues. The aim of the study was to compare the effect of different regimens of enoxaparin on the results of intensive care in patients with acute respiratory distress syndrome (ARDS) caused by SARS-nCoV.Materials and methods. A single-center prospective comparative study was conducted, which for the period May-October 2020 included 91 patients with severe coronavirus disease with the development of bilateral pneumonia and ARDS. Depending on the dosage regimen of enoxaparin, patients were divided into three groups. Patients of group 1 (n = 14) received 4000 anti-Xa MO of enoxaparin per day, group 2 (n = 20) – 8000-1200 anti-Xa MO, group 3 (n = 57) – 1600–2000 anti-Xa MO / days. Statistical analysis of the results was performed using the program «Statistica 10». Estimated median, minimum and maximum values, standard deviation. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p <0.05. Data are presented as M ± SD [min-max]. The relative risk (RR) and the odds ratio (OR) of adverse events (thromboembolic complications and mortality) were assessed.Results. In group 1, 9 episodes of pulmonary embolism were recorded, which corresponds to 64.3%, in group 2 – 7 episodes (35.0%), and in group 3 – 13 (22.4%), (p13 = 0.04 ). The overall mortality rate was 69.23% and was significantly lower in group 3 – 56.9% than in group 1 – 92.9%, and group 2 – 85.0%.Conclusions. The use of therapeutic doses of enoxaparin is one of the key areas of therapy and has a positive effect on outcomes in patients with coronavirus disease, reducing the incidence of thromboembolic complications.