ROLE OF THROMBODYNAMICS GLOBAL COAGULATION TEST IN IMPROVING TREATMENT RESULTS IN PATIENTS WITH CORONAVIRUS INFECTION AT A COVID-19 HOSPITAL

Abstract

The aim of the study was to evaluate the effectiveness of the global coagulation test of thrombodynamics for monitoring and correcting the hemostatic system and improving the results of complex treatment in patients with SARS-CoV-2 in the COVID hospital. From April 2020 to December 2020 on the basis of the University Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University) of the Ministry of Health of the Russian Federation 245 patients between the ages of 27 and 89 with SARS-CoV-2 associated pneumonia were treated. The mean age of the patients was 56.7 ± 4.2 years. All patients participating in the study were divided by simple randomization into two groups. The volume of lesion of the lung parenchyma was assessed according to the data of computed tomography. All patients were treated for SARS-CoV-2 in a comprehensive manner in accordance with the temporary guidelines of the Ministry of Health of the Russian Federation with the mandatory prescription of low molecular weight heparins (LMWH). Assessment and correction of the hemostasis system in 177 patients (47.7%) of group 1 was carried out daily using local coagulation tests (LCT), including APTT, PT, TT, PTI, INR, Fibrinogen and D-dimer level. The second group included 128 patients (52.3%), who, in addition to local coagulation tests, used the integral coagulation test - the thrombodynamics test- to assess and correct the state of the hemostatic system. Assessment and correction of hemostasis were performed at the control points (1, 7, 14 days) of the study. Compared to LCT, the thrombodynamics test reliably more often revealed the state of hypercoagulability, which was promptly corrected by increased doses of LMWH in group 2. Positive dynamics of clinical symptoms were detected in patients of group 2 1.8 times more often than in group 1 (p<0.05): fever and shortness of breath in group 2 decreased faster, the SpO2 index recovered more rapidly, especially in patients with severe hypoxia (with SpO2<90), the number of patients with moderate and severe severity by the third point of the study in group 2 was 1.8 times less than in group 1 (p<0.05). Severe forms of lung damage (CT-3 and CT-4) were detected in group 2 3.2 times less frequently (p <0.01) compared with group 1, and the number of deaths was 3.3 times less frequent (p<0.01) by the end of the study. The average bed-day in group 2 of patients (15±1.6 days) was 1.6 times shorter than in group 1 (24±7.2 days). Hemorrhagic complications were not recorded, despite the therapeutic doses of LMWH in patients of group 2. The severity of the condition of patients with SARS-CoV-2 and the dynamics of their symptoms depend on the state of microcirculation in the lungs and in the periphery and on the volume of thrombotic lesions. Anticoagulant therapy prescribed as early as possible in adequate therapeutic doses in patients with SARS-CoV-2 associated viral pneumonia made it possible to achieve positive treatment results. The use of the global coagulation thrombodynamics test has shown high efficiency for the timely assessment and correction of the state of the hemostasis system.