SARS-COV-2 AND HYPERCOAGULATION IN PREGNANT WOMEN

Abstract

The global pandemic caused by the SARS-CoV-2 virus has created unprecedented medical and social problems. The virus has the ability to induce a prothrombotic state, which in certain cases has led to severe thrombotic complications. Scientists all over the world were faced with the task of studying in detail the coagulation capacity of blood plasma and the procoagulant role of platelets in the development of pathogenic mechanisms of endothelial damage, major vascular thrombosis and systemic microangiopathies. These studies will be useful for clinicians to improve pathogenetic- based treatment schemes for this disease and to prevent serious complications. The aim of the study was to determine the eff ect of the SARS-CoV-2 virus on some parameters of the blood coagulation system in pregnant women with post-covid syndrome.Method and materials. From November 2020 to January 2022, we conducted a prospective cohort study of 50 pregnant women (main group) with SARS-CoV-2 confi rmed by the polymerase chain reaction method. The control group consisted of 25 women with physiological pregnancy who were undergoing inpatient treatment at the communal non-profi t enterprise «Ternopil City Communal Hospital No. 2». The conduct of this study was approved by the Ethics Committee of Ternopil National Medical University named after I. Gorbachevsky – protocol No. 61 dated November 13, 2020. Pregnant women were examined between 30 and 34 weeks of gestation. In the selected blood samples, the number of platelets, coagulogram indicators: international normalized ratio, prothrombin and thrombin time, prothrombin index, activated partial thromboplastin time, fi brinogen and D-dimer levels were studied. The studies were performed on a Coag Chrom 3003 analyzer. Microsoft Excel and Statistica-10 software were used for statistical analysis. The study was conducted within the framework of the National Development Program «Improvement of diagnosis and treatment of pregnant women with a burdened somatic history» of the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, TernopilNational Medical University named after I. Ya. Gorbachevsky, state registration number N 0121U100153, performance period 2021-2023).Results. A signifi cant decrease in the absolute platelet count to less than 100,000/μL was observed in 5 % of the pregnant women in the main group, and in 70 % of the patients in this group, the platelet count was less than 150,000/μL, and only 25 % of the pregnant women in this group had platelet counts within the normal range. In the control group, only 16 % of the platelets were in the 150-180 range, and 84 % of the pregnant women in this group had platelet counts within the normal range. Prothrombin time indicators were slightly longer in patients with COVID-19 (15.6 s; 14.4-16.3) compared with the control group (13.6 s; 13.0-14.3), (Р>0.05). In pregnant women with SARS-CoV-2, the concentration of fi brinogen was 1.63 times higher than in the control group (P<0.05). The indicators of activated partial thromboplastin time and international normalized ratio were longer in the group of patients with COVID-19 compared with the control group, although the diff erence was not statistically signifi cant (P>0.05). A signifi cant (P<0.05) acceleration of the thrombin time was observed in 82 % of the pregnant women in the main group compared to the control group. An increase in D-dimer concentration was the most signifi cant abnormality. Thus, when evaluating the indicators of laboratory studies of the main parameters of hemostasis in 26 % of patients with COVID-19, D-dimer increased fi ve times, and in 20 % it was 8-10 times more than in healthy pregnant women. Thus, the SARS-CoV-2 virus has a negative eff ect on the main indicators of both theprocoagulant and anticoagulant systems of homeostasis. And these changes are particularly dangerous for pregnant women, because micro- and macrothrombosis of the placenta and umbilical cord lead to life-threatening conditions for the fetus. The SARS-CoV-2 virus leads to hypercoagulation in the homeostatic system of pregnant women compared to control women who were not infected with the coronavirus. Conclusion: Thus, the results of our research allow us to pathogenetically justify the need for long-term use of anticoagulant therapy in pregnant women with post- CoV syndrome.