Postcovid syndrome: regarding the risks of developing thrombotic complications in patients with ischemic limb lesions (clinical cases)
Keywords:сovid-19, endotheliocytes, thrombotic complications, thrombovasculitis
The problem of postcovidal syndrome is currently relevant, since in the stabilization of vital functions, the processes of immunological inflammation with significant disorders of endothelium functions continue; this causes tissue ischemization, especially in the presence of changes at the level of microcirculation in patients with angiopathy and vasculopathy. It is noted that in COVID-19 comorbidity with hypertension, coronary heart disease, diabetes mellitus, systemic connective tissue diseases the risks, course, prognosis and development of vascular complications significantly increase. The severity of the inflammatory process and predicting the likelihood of complications is accompanied by changes in laboratory indicators, namely: in the general blood test – leukocytosis, an increase in the level of neitrophilic granulocytes, a decrease in the content of hemoglobin and platelets; in biochemical indicators – a decrease in the level of the general protein, an increase in the indicators of alaninetransferase, aspartaminotransferase, C-reactive protein, lactatdehydrogenase, ferritin; coagulation changes – increase in the level of fibrinogen, D-dimer, reduction of activated partial thromboplastic time. On the basis of the considered clinical cases, taking into account modern ideas about the peculiarities of the development of thrombotic complications in COVID-19 infection in patients with ischemic lesions of the extremities, the need to prescribe low molecular weight heparin as a selection drug for the treatment of thrombophilic conditions has been proven. Detailed study of histological material is important for establishing changes at the level of microcirculation and ischemization of tissues, this will allow to develop algorithms for the treatment and prevention of complications. Solving these issues, not only in the presence of COVID-19, but also in any stressful cases, requires careful clarification of the mechanisms for the development of complications and a timely adequate integrated approach to treatment to improve and stabilize the condition of patients.
Galstyan GM. [Coagulopathy in COVID-19]. Pulmonologiya. 2020;30(5):645-57. Russian. doi: https://doi.org/10.18093/0869-0189-2020-30-5-645-657
Chebotareva NV, Berns AS, Lebedeva MV, Moiseev SV. [Clinical impact of plasma haemostasis disorders and their correction in chronic glomerulonephritis with nephrotic syndrome]. Gematologiya i transfuziologiya. 2020;65(4):473-82. Russian. doi: https://doi.org/10.35754/0234-5730-2020-65-4-473-482
Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from COVID-19. PLoS ONE. 2020;15(7):e0235458. doi: https://doi.org/10.1371/journal.pone.0235458
Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20. doi: https://doi.org/10.1056/NEJMoa2002032
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. doi: https://doi.org/10.1016/S0140-6736(20)30183-5
Levi M, Thachil J, Iba T, et al. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):438-40. doi: https://doi.org/10.1016/S2352-3026(20)30145-9
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
Delcroix M, Torbicki A, Gopalan D, et al. ERS Statement on Chronic Thromboembolic Pulmonary Hypertension. European Respiratory Journal. 2020. doi: https://doi.org/10.1183/13993003.02828-2020
Strangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases. Published Online First: 27 January 2021. 2021;0:1-13. doi: http://dx.doi.org/10.1136/annrheumdis-2020-219498
Ashour HM, Elkhatib WF, Rahman M, et al. Insights into the recent 2019 novel coronavirus SARS-CoV-2 in light of past human coronavirus outbreaks. Pathogens. 2020;9(3):1-15. DOI: https://doi.org/10.3390/pathogens9030186
Iba T, Miki T, Hashiguchi N, et al. Is the neutrophil a “prima donna” in the procoagulant process during sepsis? Crit. Care. 2014;18(4):230. doi: https://doi.org/10.1186/cc13983
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):1023-6. doi: https://doi.org/10.1111/jth.14810
Marongiu F, Grandone E, Barcellona D. Pulmonary thrombosis in 2019-nCoV pneumonia? J. Tromb. Haemost. 2020;18(6):1511-13. doi: https://doi.org/10.1111/jth.14818
New COVID-19 HOPE clinical trial recommendations introduced today may reduce or eliminate mechanical ventilation for coronavirus patients. Bio¬Space. 2020 Mar 30.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Internal Medicine. 2020;180(7):934. doi: https://doi.org/10.1001/jamainternmed.2020.0994
How to Cite
Copyright (c) 2021 Medicni perspektivi (Medical perspectives)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.