Hemostasis system in COVID-19 patients with heparin therapy

Bulanov A.Y.

N.V. Sklifosovsky Research Institute of Emergency Medicine

ORCID: 0000-0001-6999-8145

Bulanova E.L.

Municipal Clinical Hospital No. 52

Simarova I.B.

Moscow City Hospital No. 52;
Sklifosovsky Research Institute for Emergency Care

Bovt E.A.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology;
Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Eliseeva O.O.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology;
Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Panteleev M.A.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology;
Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences;
Lomonosov Moscow State University;
Moscow Institute of Physics and Technics (National Research University)

Rumyantsev A.G.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology

Ataullakhanov F.I.

Karamzin S.S.

Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Hemostasis system in COVID-19 patients with heparin therapy

Authors:

Bulanov A.Y., Bulanova E.L., Simarova I.B., Bovt E.A., Eliseeva O.O., Panteleev M.A., Rumyantsev A.G., Ataullakhanov F.I., Karamzin S.S.

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Journal: Russian Journal of Preventive Medicine. 2020;23(6): 85‑93

DOI: 10.17116/profmed20202306185

Downloaded: 81

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To cite this article:

Bulanov AY, Bulanova EL, Simarova IB, et al. . Hemostasis system in COVID-19 patients with heparin therapy. Russian Journal of Preventive Medicine. 2020;23(6):85‑93. (In Russ.)
https://doi.org/10.17116/profmed20202306185

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MATERIAL AND METHODS

Global thrombodynamics (TD) and thromboelastography (TEG) tests, as well as coagulogram screening tests (APTT, PT, INR, and fibrinogen) were performed in 136 patients with COVID-19 observed in a hospital setting. All patients received low molecular weight heparins at therapeutic dosages relatively to body weight in accordance with the hospital protocol for patients with COVID-19.

RESULTS

In patients prior to treatment, marked hypercoagulability was observed in all global tests. The main parameters of TD (clot growth rate Vi and Vs) exceeded the reference range in more than 83% and 75% of patients, respectively. Citrate native TEG parameters (R, K, angle α and MA) also showed hyper-coagulation before anticoagulant therapy initiation in 24%, 17%, 48% and 53% of patients, respectively. After the start of treatment, a significant heparin response was obtained for the Vs parameter (the most sensitive to heparin parameter of TD): in 75% of cases, TD recorded hypo-coagulation, in 15% — normocoagulation, and in 10% of measurements, TD parameters continued to be in the hyper-coagulation range. The TEG parameter most sensitive to heparin (angle α) showed a lower response to heparin: it registered hypo-coagulation only in 25% of measurements, in 60% — normocoagulation, and in 15% the parameter was in the hyper-coagulation range.

CONCLUSION

The significant share of hypercoagulant results (10-15%) may indicate that some patients have not achieved a sufficient anticoagulant effect under the therapy.

Keywords:

COVID-19

hemostasis

heparin

control of anticoagulant therapy

coagulogram

global blood coagulation tests

thrombodynamics

thromboelastography

Authors:

Bulanov A.Y.

N.V. Sklifosovsky Research Institute of Emergency Medicine

ORCID: 0000-0001-6999-8145

Bulanova E.L.

Municipal Clinical Hospital No. 52

Simarova I.B.

Moscow City Hospital No. 52;
Sklifosovsky Research Institute for Emergency Care

Bovt E.A.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology;
Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Eliseeva O.O.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology;
Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Panteleev M.A.

Rumyantsev A.G.

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology

Ataullakhanov F.I.

Karamzin S.S.

Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences

Received:

16.10.2020

Accepted:

29.10.2020

List of references:

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844-847.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J, Wang S, Chao Y, Yang Z, Xu J, Zhou X, Chen D, Xiong W, Xu L, Zhou F, Jiang J, Bai C, Zheng J, Song Y. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. https://doi.org/10.1001/jamainternmed.2020.0994
Ranucci M, Ballotta A, Di Dedda U, Bayshnikova E, Dei Poli M, Resta M, Falco M, Albano G, Menicanti L. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020; 18(7):1747-1751. https://doi.org/10.1111/jth.14854
Maatman TK, Jalali F, Feizpour C, Douglas A, 2nd, McGuire SP, Kinnaman G, Hartwell JL, Maatman BT, Kreutz RP, Kapoor R, Rahman O, Zyromski NJ, Meagher AD. Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019. Crit Care Med. 2020;48(9):783-790. https://doi.org/10.1097/CCM.0000000000004466
Cattaneo M, Bertinato EM, Birocchi S, Brizio C, Malavolta D, Manzoni M, Muscarella G, Orlandi M. Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified? Thromb Haemost. 2020;120(8):1230-1232. https://doi.org/10.1055/s-0040-1712097
Ataullakhanov FI, Koltsova EM, Balandina AN, Serebriyskiy, II, Vuimo TA, Panteleev MA. Classic and Global Hemostasis Testing in Pregnancy and during Pregnancy Complications. Semin Thromb Hemost. 2016;42:696-716.
Panteleev MA, Hemker HC. Global/integral assays in hemostasis diagnostics: promises, successes, problems and prospects. Thromb J. 2015;13:5.
Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, Pesenti A, Peyvandi F, Tripodi A. Hypercoagulability of COVID-19 patients in Intensive Care Unit. A Report of Thromboelastography Findings and other Parameters of Hemostasis. J Thromb Haemost. 2020;18(7): 1738-1742. https://doi.org/10.1111/jth.14850
Spiezia L, Boscolo A, Poletto F, Cerruti L, Tiberio I, Campello E, Navalesi P, Simioni P. COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure. Thromb Haemost. 2020;120(6):998-1000. https://doi.org/10.1055/s-0040-1710018
Pavoni V, Gianesello L, Pazzi M, Stera C, Meconi T, Frigieri FC. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. J Thromb Thrombolysis. 2020; 50(2):281-286. https://doi.org/10.1007/s11239-020-02130-7
Dashkevich NM, Vuimo TA, Ovsepyan RA, Surov SS, Soshitova NP, Panteleev MA, Ataullakhanov FI, Negrier C. Effect of pre-analytical conditions on the thrombodynamics assay. Thromb Res. 2014;133:472-476.
Balandina AN, Serebriyskiy II, Poletaev AV, Polokhov DM, Gracheva MA, Koltsova EM, Vardanyan DM, Taranenko IA, Krylov AY, Urnova ES, Lobastov KV, Chernyakov AV, Shulutko EM, Momot AP, Shulutko AM, Ataullakhanov FI. Thrombodynamics-A new global hemostasis assay for heparin monitoring in patients under the anticoagulant treatment. PLoS One. 2018; 13:e0199900.

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