Peculiarities of hemostasis in patients with COVID-19

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Abstract

Aim. Analysis of the dynamics of different stages of clot formation and its lysis in patients with different COVID-19 severity.

Materials and methods. We prospectively included 58 patients with COVID-19 (39 patients with moderate disease severity and 18 patients with severe disease) and 47 healthy volunteers as a control group. All participants underwent the assessment of flow-mediated dilation (FMD) of brachial artery, impedance aggregometry, rotational thromboelastometry and thrombodynamics. Von Willebrand factor antigen (vWF:Ag) quantification was also performed in patients with COVID-19. Measurements were repeated on the 3rd and 9th day of hospitalization.

Results. Compared to the control group, patients with COVID-19 showed reduced values of platelet aggregation and greater values of the clot growth rate, as well as its size and density. On the first day of hospitalization, we found no differences in the activity of plasma hemostasis and endogenous fibrinolysis between subgroups of patients. With the progression of the disease, the growth rate and size of the clot were higher in the severe subgroup, even despite higher doses of anticoagulants in this subgroup. An increase in platelet aggregation was noted during the progression of the disease, especially in the severe subgroup. There were no differences in the results of the FMD test by subgroups of patients. The vWF:Ag level was significantly higher in the severe subgroup.

Conclusion. Thus, plasma hemostasis followed by secondary platelet activation correlates with the severity of COVID-19. Patients with moderate to severe coronavirus infection have predominantly local rather than generalized endothelial dysfunction.

About the authors

Anna I. Kalinskaya

Davydovsky City Clinical Hospital; Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0003-2316-4238

канд. мед. наук, зав. отд-нием неотложной кардиологии для больных с острым инфарктом миокарда; доц. каф. кардиологии

Russian Federation, Moscow; Moscow

Oleg A. Dukhin

Davydovsky City Clinical Hospital; Yevdokimov Moscow State University of Medicine and Dentistry

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0003-2278-1154

врач-кардиолог; аспирант

Russian Federation, Moscow; Moscow

Ivan A. Molodtsov

Davydovsky City Clinical Hospital

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0001-8154-9350

медицинский статистик

Russian Federation, Moscow

Aleksandra S. Anisimova

Yevdokimov Moscow State University of Medicine and Dentistry

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0002-1215-132X

врач-ординатор

Russian Federation, Moscow

Denis A. Sokorev

Davydovsky City Clinical Hospital

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0003-4887-2185

врач-кардиолог

Russian Federation, Moscow

Antonina K. Elizarova

Davydovsky City Clinical Hospital; Yevdokimov Moscow State University of Medicine and Dentistry

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0001-8715-8916

врач-кардиолог; аспирант

Russian Federation, Moscow; Moscow

Olga A. Sapozhnikova

Davydovsky City Clinical Hospital

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0002-6520-5926

врач-кардиолог

Russian Federation, Moscow

Kseniya A. Glebova

Davydovsky City Clinical Hospital

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0002-2559-9449

врач-кардиолог

Russian Federation, Moscow

Soslan S. Shakhidzhanov

Center for Theoretical Problems of Physicochemical Pharmacology

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0002-5677-8052

науч. сотр. лаб. биофизики

Russian Federation, Moscow

Ilia S. Spiridonov

Center for Theoretical Problems of Physicochemical Pharmacology

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0001-7514-0559

вед. инженер отдела разработок

Russian Federation, Moscow

Fazly I. Ataullakhanov

Center for Theoretical Problems of Physicochemical Pharmacology; University of Pennsylvania

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0003-3403-181X

канд. физ.-мат. наук, д-р биол. наук, проф., гл. науч. сотр.; приглашенный проф.

Russian Federation, Moscow; Philadelphia, USA

Alexander V. Shpektor

Yevdokimov Moscow State University of Medicine and Dentistry

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0001-6190-6808

чл.-кор. РАН, д-р мед. наук, проф., рук-ль Университетской клиники кардиологии

Russian Federation, Moscow

Elena Yu. Vasilieva

Davydovsky City Clinical Hospital; Yevdokimov Moscow State University of Medicine and Dentistry

Email: kalinskaya.anna@gmail.com
ORCID iD: 0000-0002-6310-7636

д-р мед. наук, проф., глав. врач; рук-ль лаб. атеротромбоза

Russian Federation, Moscow; Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. The results of the test for endothelium-dependent vasodilation at the 1st, 2nd and 3rd points.

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3. Fig. 2. The results of the study of impedance aggregometry at the 1st, 2nd and 3rd points.

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4. Fig. 3. The results of the study of rotational thromboelastometry at time points 1, 2 and 3.

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5. Fig. 4. The results of the thrombodynamic study at time points 1, 2 and 3.

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