Authors
Agapov A.B.1, 2, Kalinin R.E.1, Mzhavanadze N.D.1, Povarov V.O.1, Nikiforov A.A.1, Maksaev D.A.1, 3, Chobanyan A.A.3, Suchkov I.A. 1
1 Ryazan State Medical University named after Academician I.P. Pavlova, Ryazan
2 Regional Clinical Hospital, Ryazan
3 City Clinical Hospital of Emergency Medical Care, Ryazan
Abstract
Purpose of the study: to analyze the inflammatory markers MCP1, IP 10 and platelet apoptosis markers phosphatidylserine and calreticulin during anticoagulant therapy (ACT) in patients with COVID-19.
Material and methods. The study included 370 patients. The patients were divided into 3 groups: group 1 — 190 people who received low molecular weight heparin (LMWH); Group 2 — 123 people taking unfractionated heparin (UFH); Group 3 — 57 people taking direct oral anticoagulants (DOACs). All patients upon admission and at the end of hospital treatment were assessed for general laboratory parameters, as well as the dynamics of specific markers of inflammation (IP-10 and MCP-1) and platelet apoptosis (phosphatidylserine and calreticulin) from July 2021 to January 2022.
Results. The study groups at the beginning of ACT were comparable in age, severity of COVID-19 and laboratory parameters, which had high values. In patients receiving LMWH (group 1), there was a significant decrease in specific pro-inflammatory cytokines (IP-10, MCP1), while apoptosis rates increased by the end of ACT in the hospital. In group 2 (UFH group), among specific markers, only IP-10 decreased, and MCP-1, phosphatidylserine and calreticulin showed no changes. In group 3 of patients taking DOACs, there was also a decrease in the level of IP 10, and the levels of MCP-1, phosphatidylserine and calreticulin were without significant differences from the start of ACT. When assessing the incidence of VTEC development, it was noted that in patients receiving UFH there was a high incidence of isolated PE without a source in the lower extremities — 11.40% of cases, DVT and PE with a source in the lower extremities (6.5% and 6.5% of cases, respectively) , in comparison with patients taking LMWH (1.6%, 1.1% and 0.5% of cases, respectively).
Conclusion. The initial level of the studied indicators in patients with COVID-19 has high values. The decrease in the level of pro-inflammatory markers (CRP, ferritin, IP-10, MCP 1) and coagulation markers (D-dimer and fibrinogen) was most pronounced in patients receiving LMWH. A statistically significant increase in apoptosis markers (phosphatidylserine and calreticulin) was observed in patients receiving VTEC prophylaxis with low molecular weight heparin.
Keywords: venous thrombotic complications, anticoagulant therapy, coronavirus infection, inflammatory markers, platelet apoptosis.
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