gms | German Medical Science

Background: In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different compared to the control group - patients with influenza.

Some studies have shown that the coronavirus (COVID-19) enters cells by binding angiotensin-converting enzyme 2, found mainly on the alveolar epithelium and endothelium.

The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis.

The goal of our study was to analyze the patients who have suffered from COVID19 and determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics.

Methods: The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhgorod, Kherson and Kyiv). We analyzed 121 patients, the age was 46.9±15.3 years, here were 64 (52.4%) men and other – women. All the patients had a positive COVID-19 PCR test. The changes in D-dimer were analysed (Table 1 [Tab. 1]). In 41 (33,9%) patients there were thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases.

Results: An increase in D-dimer level is observed in most patients and is not associated with the clinical manifestations of thrombosis. At a D-dimer level of 11000–10564 ng/ml the patients had clinical symptoms of thrombotic condition, which was confirmed by CT or US. With an increase over 725–7000 ng/ml, there were no clinical signs of thrombosis.

We performed standard medical therapy for patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 7 patients and in 1 case – direct catheter thrombolysis.

Conclusion: In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 900 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. According to our study we didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, BMI and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Thrombectomy from a femoral artery was successfully performed in 8 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time.