The use of the thrombodynamics test in the diagnostics of hemostasis disorders in patients with COVID-19 of varying severity
- Authors: Krechetova L.V.1, Nechipurenko D.Y.2,3,4, Shpilyuk M.A.1, Beznoshchenko O.S.1, Beresneva E.A.2, Markelov M.I.1, Ivanets T.Y.1, Gavrilova T.Y.1, Kozachenko I.F.1, Esayan R.M.1, Pyregov A.V.1, Khachatryan N.A.1, Kodatskii D.S.1, Spiridonov I.S.2, Dolgushina N.V.1, Gorodnova E.A.1, Ataullakhanov F.I.2,3,4, Rumyantsev A.G.4, Degtyarev D.N.1
-
Affiliations:
- Research Center for Obstetrics, Gynecology and Perinatology
- 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
- Issue: Vol 12, No 4 (2021)
- Pages: 23-37
- Section: Original Study Articles
- URL: https://journals.rcsi.science/clinpractice/article/view/88138
- DOI: https://doi.org/10.17816/clinpract88138
- ID: 88138
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.
Keywords
Full Text
##article.viewOnOriginalSite##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, 117997Dmitry 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, 117997Tatiana 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, 117997Irena 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, 117997Rosa 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, 117997Aleksei 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, 117997Nelly 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, 117997Dmitrii 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, 117997Elena 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, 117997Fazoil 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; MoscowAlexander 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, MoscowDmitriy 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, 117997References
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Nicoll D, McPhee SJ, Pignone M, Lu CM. Pocket guide or diagnostic tests. NY: McGraw-Hill; 2008. 512 р.
- Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228–232. doi: 10.1002/ajh.23599
- 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).]
- 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
- 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
- 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