The infection with a new coronavirus of SARS-CoV-2 and the subsequent disease caused by a coronavirus (COVID-19) usually is associated with inflammation and a protrombotichesky state. Increase in level of fibrin, products of degradation of fibrin, fibrinogen and also D-dimera is observed. As a rule, these markers connect with the worst clinical outcomes. True extent of distribution of these complications at patients with different disease severity is not defined thoroughly. In some messages it is indicated higher distribution of the clotting disease connected with COVID-19 among patients of intensive care units.
Tracking of a condition of a system of coagulation at patients with COVID-19 is recommended. Not hospitalized patients with COVID-19 do not need to make regularly the tests showing a condition of a system of coagulation such as D-dimerov level, prothrombin time, level of fibrinogen or quantity of thrombocytes. Despite communication of these signs with bad clinical outcomes, at the moment there are not enough data to show a possibility of their use for allocation of separate groups among the people transferring infection with the SARS-CoV-2 virus asimptomno or benign. Hematologic and coagulative parameters are also often measured at the patients hospitalized with COVID-19. However, at the moment there are not enough data for the unambiguous recommendation pro or contra use of these indicators for definition of a course of treatment.
Selection of anticoagulants or antithrombocytic drugs for patients with COVID-19 is recommended to be carried out taking into account potential interaction of these drugs with other used drugs. Low-molecular heparin or unfractionated heparin can be more preferable to use for the hospitalized patients in a critical state because of shorter half-life, a possibility of intravenous or hypodermic use and smaller extent of interaction of drugs in comparison with oral anticoagulants.
Taking into account that adequate control of MNO is complicated in the conditions of isolation, the ambulatory patients accepting warfarin can be candidates for oral anticoagulating therapy by direct anticoagulants. Patients with mechanical heart valves, devices for support of ventricles, fibrillation of auricles or an anti-phospholipidic syndrome and also the women nursing have to continue treatment by warfarin. Patients with COVID-19 which is on anticoagulating or antithrombocytic therapy for treatment of background diseases are recommended to continue antitrombotichesky therapy, except for cases of considerable bleeding or other contraindications.
For not hospitalized patients with COVID-19 anticoagulating or antithrombocytic therapy for prevention of a venous tromboembolizm or in therapeutic doses should not be appointed. To the hospitalized adult patients with COVID-19 prevention of a venous tromboembolizm has to be appointed according to recommendations for the patients hospitalized according to other indications (excepting cases of existence of contraindications: active bleeding or heavy thrombocytopenia). The data which are the cornerstone of this recommendation are rather limited. As for children, recent meta-analysis of an infection of COVID-19 among children did not bring up a question of a venous tromboembolizm. Taking into account insufficiency of data, infection of COVID-19 should not influence recommendations about prevention of a venous tromboembolizm for the hospitalized children. Also anticoagulating or antithrombocytic therapy should not be appointed for prevention of arterial thrombosis beyond the scope of standards of care for patients without COVID-19. Anti-coagulation is often applied to prevention of an arterial tromboembolizm among patients with cardiac arrhythmia. Though data on cases of a stroke and a myocardial infarction among patients with COVID-19 are available, the prevalence of these cases is still unknown.
To patients with COVID-19 which have tromboembolic episodes or suspicion on a clotting disease in the conditions of impossibility of scanning treatment by therapeutic doses of anticoagulants, according to standards of care for patients without COVID-19 has to be appointed. At the moment there are not enough data for the recommendation pro or contra purpose of therapeutic doses antitrombotichesky or thrombolytic means to the hospitalized patients. Conducting further randomized studies in this direction is recommended.