The use of the thrombodynamics test in the diagnostics of hemostasis disorders in patients with COVID-19 of varying severity

Cover Page

Cite item

Full Text

Abstract

Background: At the present moment, an urgent and unresolved problem is the search for a method to diagnose disorders of the hemostasis system in patients with the new coronavirus infection. The integral tests, in particular, the thrombodynamics test, will presumably make it possible to monitor changes in blood clotting, and predict the course of the disease in patients with COVID-19.

Aims: To comparatively assess the plasma hemostasis parameters and results of the thrombodynamics test in patients with COVID-19 viral infection of different severity.

Methods: The study included 96 patients with a confirmed diagnosis of COVID-19, admitted to a hospital for infectious diseases on the base of the V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology in the period from April 23, 2020, to June 20, 2020, and discharged at the end of treatment. SARS-CoV-2 was identified by PCR. The patients were stratified by the severity into 3 groups: mild course (n=25), moderate course (n=54), severe course (n=17). The diagnostics and treatment of patients were carried out in accordance with the Temporary Methodological Recommendations of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of the new coronavirus infection, versions 5, 6, 7. In the course of the treatment, the patients were assessed for APTT, prothrombin %, prothrombin time (PT) and thrombin time, fibrinogen, D-dimer, platelet count, and the thrombodynamic test parameters (V/Vi/Vst, Tlag, Cs, D).

Results: Significant differences were observed in the thrombin time, D-dimer, platelet count, and the thrombodynamic parameters of V/Vst, Cs, and D taken before admission and a week after admission. We found a relationship between the parameters of hemostasis (fibrinogen concentration, PT, prothrombin %, APTT, Tlag, D) and the duration of hospital stay. There was a positive relationship between the content of fibrinogen and D (r=0.6307, p <0.0001) and a strong positive relationship between PT and Tlag (r=0.7499, p <0.0001).

Conclusions: The thrombodynamics test can be recommended as a potential tool for a personalized approach to monitoring the hemostasis system and treating patients with COVID-19.

About the authors

Liubov V. Krechetova

Research Center for Obstetrics, Gynecology and Perinatology

Email: l_krechetova@oparina4.ru
ORCID iD: 0000-0001-5023-3476
SPIN-code: 1201-4297

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Dmitry Yu. Nechipurenko

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

Email: ne4ipur@gmail.com
ORCID iD: 0000-0002-8677-129X
Russian Federation, Moscow; Moscow; Moscow

Margarita A. Shpilyuk

Research Center for Obstetrics, Gynecology and Perinatology

Email: tambovtsevamr@mail.ru
ORCID iD: 0000-0001-5145-7981
SPIN-code: 9577-6802
Russian Federation, 4, akademika Oparina street, Moscow, 117997

Olga S. Beznoshchenko

Research Center for Obstetrics, Gynecology and Perinatology

Email: o_beznoshchenko@oparina4.ru
ORCID iD: 0000-0003-4645-8976
SPIN-code: 2780-1056
Russian Federation, 4, akademika Oparina street, Moscow, 117997

Evgeniya A. Beresneva

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

Email: jeresneva@gmail.com
Russian Federation, Moscow

Mikhail I. Markelov

Research Center for Obstetrics, Gynecology and Perinatology

Email: m.markelov1994@mail.ru
Russian Federation, 4, akademika Oparina street, Moscow, 117997

Tatiana Yu. Ivanets

Research Center for Obstetrics, Gynecology and Perinatology

Email: t_ivanets@oparina4.ru
ORCID iD: 0000-0002-7990-0276
SPIN-code: 3103-6737

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Tatiana Yu. Gavrilova

Research Center for Obstetrics, Gynecology and Perinatology

Email: t_qavrilova@oparina4.ru
ORCID iD: 0000-0001-7424-4292

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Irena F. Kozachenko

Research Center for Obstetrics, Gynecology and Perinatology

Email: i_kozachenko@oparina4.ru
ORCID iD: 0000-0003-1822-9164

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Rosa M. Esayan

Research Center for Obstetrics, Gynecology and Perinatology

Email: r_esayan@oparina4.ru
ORCID iD: 0000-0002-6808-113X

M.D., Ph.D.

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Aleksei V. Pyregov

Research Center for Obstetrics, Gynecology and Perinatology

Email: a_pyregov@oparina4.ru
ORCID iD: 0000-0001-8382-9671
SPIN-code: 5456-0224

M.D., Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Nelly A. Khachatryan

Research Center for Obstetrics, Gynecology and Perinatology

Email: n_khachatryan@oparina4.ru
ORCID iD: 0000-0001-6833-1787

M.D., Ph.D.

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Dmitrii S. Kodatskii

Research Center for Obstetrics, Gynecology and Perinatology

Email: d_kodatskiy@oparina4.ru
ORCID iD: 0000-0001-9707-3473
Russian Federation, 4, akademika Oparina street, Moscow, 117997

Ilya S. Spiridonov

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

Email: ilia.s.spiridonov@gmail.com
ORCID iD: 0000-0001-9445-1184
Russian Federation, Moscow

Nataliya V. Dolgushina

Research Center for Obstetrics, Gynecology and Perinatology

Email: n_dolgushina@oparina4.ru
SPIN-code: 1725-9876

M.D., Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Elena A. Gorodnova

Research Center for Obstetrics, Gynecology and Perinatology

Email: e_gorodnova@oparina4.ru
ORCID iD: 0000-0002-9524-4416

M.D., Ph.D.

Russian Federation, 4, akademika Oparina street, Moscow, 117997

Fazoil I. Ataullakhanov

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

Email: ataullakhanov.fazly@gmail.com
ORCID iD: 0000-0003-3403-181X
SPIN-code: 7250-0891

Ph.D., Dr. Sci. (Biol.), Professor, Corresponding Member of the Russia Academy of Sciences

Russian Federation, Moscow; Moscow; Moscow

Alexander G. Rumyantsev

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

Author for correspondence.
Email: alexrum47@mail.ru
ORCID iD: 0000-0002-5331-448X
SPIN-code: 2227-6305

M.D., Ph.D., Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences

Russian Federation, Moscow

Dmitriy N. Degtyarev

Research Center for Obstetrics, Gynecology and Perinatology

Email: d_degtiarev@oparina4.ru
ORCID iD: 0000-0001-8975-2425
SPIN-code: 2309-4007

MD, Ph.D., Dr. Sci. (Med.), Professor

Russian Federation, 4, akademika Oparina street, Moscow, 117997

References

  1. Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094–1099. doi: 10.1111/jth.14817
  2. Xie Y, Wang X, Yang P, et al. COVID-19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imaging. 2020; 2(2):e200067. doi: 10.1148/ryct.2020200067
  3. Schmitt FC, Manolov V, Morgenstern J, et al. Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study. Ann Intensive Care. 2019;9(1):19. doi: 10.1186/s13613-019-0499-6
  4. Simundic AM, Bolenius K, Cadamuro J, et al. On behalf of the Working Group for Preanalytical Phase (WG-PRE), of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) Joint EFLM-COLABIOCLI Recommendation for venous blood sampling v 1.1. Clinical Chemistry and Laboratory Medicine; June, 2018.
  5. Маркелов М.И., Безнощенко О.С., Иванец Т.Ю., и др. Особенности системы плазменного гемостаза у пациентов с новой коронавирусной инфекцией COVID-19 // Акушерство и гинекология. 2020. № 9. С. 138–144. [Markelov MI, Beznoshchenko OS, Ivanets TY, et al. Features of the plasma hemostasis system in patients with the new coronavirus infection COVID-19. Obstetrics Gynecology. 2020;(9):138–144. (In Russ).] doi: 10.18565/aig.2020.9.138-144
  6. Helms J, Tacquard C, Severac F, et al. CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6): 1089–1098. doi: 10.1007/s00134-020-06062-x
  7. Pavoni V, Gianesello L, Pazzi M, et al. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. J Thromb Thrombolysis. 2020;50(2):281–286. doi: 10.1007/s11239-020-02130-7
  8. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5
  9. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta analysis. Clin Chim Acta. 2020;506:145–148. doi: 10.1016/j.cca.2020.03.022
  10. 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(4):844–847. doi: 10.1111/jth.14768
  11. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023–1026. doi: 10.1111/jth.14810
  12. Nicoll D, McPhee SJ, Pignone M, Lu CM. Pocket guide or diagnostic tests. NY: McGraw-Hill; 2008. 512 р.
  13. Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228–232. doi: 10.1002/ajh.23599
  14. Атауллаханов Ф.И., Баландина А.Н., Варданян Д.М., и др. Применение теста тромбодинамики для оценки состояния системы гемостаза. Учебно-методические рекомендации. Москва, 2015. 72 с. [Ataullakhanov FI, Balandina AN, Vardanyan DM, et al. Application of the thrombodynamics test to assess the state of the hemostasis system. Educational and methodological recommendations. Moscow; 2015. 72 р. (In Russ).]
  15. Баландина А.Н., Кольцова Е.М., Шибеко А.М., и др. Тромбодинамика: новый подход к диагностике нарушений системы гемостаза // Вопросы гематологии, онкологии и иммунопатологии в педиатрии. 2018. Т. 17, № 4. С. 114–126. [Balandina AN, Koltsova EM, Shibeko AM, et al. Thrombodynamics: a new approach to the diagnosis of hemostatic disorders. Issues of Hematology, Oncology and Immunopathology in Pediatrics. 2018;17(4):114–126. (In Russ).] doi: 10.24287/1726-1708-2018-17-4-114-126
  16. Lipets E, Vlasova O, Urnova E, et al. Circulating contact-pathwayactivating microparticles together with factors IXa and XIa induce spontaneous clotting in plasma of hematology and cardiologic patients. PLoS One. 2014;9(1):e87692. doi: 10.1371/journal.pone.0087692
  17. Бовт Е.А., Бражник В.А., Буланов А.Ю., и др. Результаты многоцентрового мониторинга показателей гемостаза у больных с COVID-19 // Педиатрия. Журнал им. Г.Н. Сперанского. 2020. Т. 99, № 6. С. 62–73. [Bovt EA, Brazhnikova VА, Bulanov AY, et al. Results of multicenter monitoring of hemostasis indicators in patients with COVID-19. Pediatrics. 2020;99(6):62–73. (In Russ).] doi: 10.24110/0031-403X-2020-99-6-62-73

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Coagulation parameters in patients with COVID-19 of different severity, change over time. Note. The upper / lower dashed line is the laboratory reference interval; straight line — trend line; X-axis — the time of hospital stay (per day), Y-axis — сoagulation parameters.

Download (2MB)
Indexing metadata
3. Fig. 2. The thrombodynamics test parameters in patients with COVID-19 of different severity, change over time. Note. The upper / lower dashed line is the laboratory reference interval; straight line — trend line; X-axis — the time of hospital stay (per day), Y-axis — Thrombodynamics parameters.

Download (2MB)
Indexing metadata

Copyright (c) 2021 Krechetova L.V., Nechipurenko D.Y., Shpilyuk M.A., Beznoshchenko O.S., Beresneva E.A., Markelov M.I., Ivanets T.Y., Gavrilova T.Y., Kozachenko I.F., Esayan R.M., Pyregov A.V., Khachatryan N.A., Kodatskii D.S., Spiridonov I.S., Dolgushina N.V., Gorodnova E.A., Аtaullakhanov F.I., Rumyantsev А.G., Degtyarev D.N.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies