Ruzhentsova T A, Khavkina D A, Chukhliaev P V, Garbuzov A A, Ploskireva A A
FSBI Gabrichevsky research institute for epidemiology and microbiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor).
FSBI Central Research Institute for Epidemiology of the Surveillance of Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor).
Vopr Virusol. 2021 Mar 7;66(1):40-46. doi: 10.36233/0507-4088-14.
Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases.
Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)» (https://static-0.minzdrav.gov.ru/system/attachments/attaches/).
The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs.
Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.
对由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的冠状病毒感染发病机制的分析表明，血液流变学紊乱对其病程和结局有重大影响。众所周知，慢性心血管疾病与COVID-19及其他传染病的重症病程和致命结局风险相关。因此，在每种情况下，都有必要研究为此类患者制定的治疗方案中不同组成部分之间的相互作用和相互影响。本研究的目的是评估凝血活性对新型冠状病毒感染（COVID-19）病程的影响，并为根据合并躯体疾病的指征以预先选定剂量接受新型口服抗凝剂（NOACs）治疗的合并症患者的管理提供依据。
分析了76例在门诊接受初始治疗的确诊冠状病毒感染患者。26例接受NOACs（利伐沙班、阿哌沙班、达比加群）治疗的患者组成主要组，50例患者组成对照组，在COVID-19发病前，对照组患者未使用任何影响血液凝固的药物。所有患者均按照《冠状病毒感染（COVID-19）的预防、诊断和治疗临时指南》（https://static-0.minzdrav.gov.ru/system/attachments/attaches/）进行治疗。
接受NOACs治疗的患者住院人数明显较少（19%，而对照组为66%）。主要组未观察到死亡或严重呼吸和/或肾衰竭病例，而未使用这些药物的患者中有14%出现了不良结局。
服用NOACs可降低由SARS-CoV-2引起的冠状病毒感染发展为重症病程和不良结局的可能性，这表明凝血机制在COVID-19发病机制中起重要作用。对于在门诊环境中接受适当口服抗凝剂治疗以治疗非重症冠状病毒感染的患者，没有指征进行药物替代和调整抗凝治疗方案。
