Venous thrombosis and embolism in surgical hospital patients in the conditions of the COVID-19 pandemic

Abstract

Background. Venous thrombosis and embolism are one of the main and most threatening complications in emergency abdominal surgery in the conditions of global pandemic caused by the SARS-CoV-2, which is constantly worsening the morbidity and mortality rates. Despite the accumulation of sufficient knowledge on the problem of venous thromboembolism in general, understanding the unique prothrombotic pathophysiology of the virus and its potentiation of the coagulation system in patients with COVID-19 remains at a suboptimal level. The purpose of the study is to assess the extent of venous thrombosis in patients undergoing emergency surgery for abdominal pathology with concomitant coronavirus disease and to determine the main measures to improve the effectiveness of prevention and treatment. Materials and methods. The results of the treatment of 3,476 patients in the Surgical center 1 of the CNPE of the Lviv Territorial Medical Union “Multidisciplinary Clinical Hospital of Intensive Treatment Methods and Emergency Medical Care” from April 2021 to March 2022 were analyzed, 89.3 % of them were hospitalized urgently. One hundred and fifty-nine (4.6 %) patients died, mainly from purulent-septic complications, multi-organ (primarily severe respiratory) failure and venous thrombosis and embolism. Results. Non-specific prevention of venous thrombosis and embolism was carried out in all patients. It consisted in elastic compression of the legs before transporting the patient to the operating room and early ambulation after surgery. Adequate analgesia and assistance from medical staff were considered an important component of motor activity recovery. Specific prevention of venous thrombosis was carried out by subcutaneous injection of low-molecular-weight heparins once or twice a day. With the beginning of the pandemic and a sharp rise of thromboembolic complications, a longer prophylaxis with increased dose and frequency of anticoagulant administration began to be used in clinical practice. Conclusions. Unresolved issues that stood in the way of optimizing the prevention of venous thrombosis and embolism in the clinic are the new challenges associated with the COVID-19 pandemic, insufficient alertness of doctors to the problem of thromboembolic complications, difficulties in objective assessment of the risk of deep vein thrombosis in the presence of many factors, absence of scales for evaluating the risk of venous thrombosis adapted to today’s conditions.