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CONTINUITY OF ANTICOAGULANT TREATMENT IN PATIENTS WITH COVID-19
Suramisova Aygul Tursinbekovna
Ph.D. Senior teacher of International Kazakh-Turkish University named after Khoja Ahmed
Yasavi; Kentau Central City Hospital, Head of the Department of Infectious Diseases,
Senior Infectious Diseases Specialist
Roziboyeva Barno Abdinabievna
Republic of Kazakhstan. Kentau Central City Hospital.
Doctor of infectious diseases of the first category.
Annotatsiya:
COVID-19 pandemiyasi davomida bemorlarning qon ivish tizimidagi o'zgarishlar,
tromboz va emboliya xavfini oshirishi sababli antikoagulyantlar bilan davolash muhim ahamiyat
kasb etdi. Ushbu annotatsiya COVID-19 bilan kasallangan bemorlarni antikoagulyantlar bilan
davolashning davomiyligi, ko'rsatmalari, xavflari va monitoringi haqida qisqacha ma'lumot
beradi. COVID-19 kasalligi ko'plab bemorlarda qon ivishining o'zgarishlariga olib keladi, bu esa
trombotik hodisalar xavfini oshiradi. Antikoagulyantlar, masalan, past molekulyar og'irlikdagi
heparinlar, trombozning oldini olish va davolashda muhim rol o'o'ynaydi.
Kalit so’zlar:
COVID-19,tromboz,emboliya,qon ivish tizimi,profilaktika davolash,dori
dozalari,qon ketish xavfi,tibbiy mutaxassislar, davolash davomiyligi, bemor,profilaktika.
Резюме:
антикоагулянтная терапия приобрела актуальность в период пандемии COVID-19
в связи с изменениями в свертывающей системе крови пациентов, повышающими риск
тромбозов и эмболий. В этом реферате представлена краткая информация о
продолжительности, показаниях, рисках и мониторинге антикоагулянтной терапии у
пациентов с COVID-19. Заболевание COVID-19 вызывает у многих пациентов изменения
свертываемости крови, что увеличивает риск тромботических событий. Антикоагулянты,
такие как низкомолекулярные гепарины, играют важную роль в профилактике и лечении
тромбозов.
Ключевые слова:
COVID-19, тромбоз, эмболия, свертывающая система крови,
профилактическое лечение, дозы препаратов, риск кровотечения, медицинские работники,
продолжительность лечения, пациент, профилактика.
Abstract:
anticoagulant therapy has gained importance during the COVID-19 pandemic due to
changes in the blood coagulation system of patients, increasing the risk of thrombosis and
embolism. This abstract provides a summary of the duration, indications, risks, and monitoring
of anticoagulant therapy in patients with COVID-19. The disease COVID-19 causes changes in
blood coagulation in many patients, which increases the risk of thrombotic events.
Anticoagulants, such as low molecular weight heparins, play an important role in the prevention
and treatment of thrombosis.
Key words:
COVID-19, thrombosis, embolism, blood coagulation system, preventive treatment,
drug doses, risk of bleeding, medical professionals, duration of treatment, patient, prevention.
Today, it has become known to everyone that the coagulation system of the blood of
patients infected with COVID-19 is one of the organs that suffer a lot of damage. This indicates
that it is the main factor in the course of the disease and one of the important factors in the
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exacerbation of the disease. As a result of damage to the blood coagulation system of almost all
patients, in addition to the development of many secondary diseases, many complications arise
after these diseases, and this condition decreases the quality of life of patients, develops
disability and reduces the ability to work or is completely incapacitated. cause. In a word, it is
not wrong to say that managing the coagulation system in sick patients is disease management.
[Accepted by the Ministry of Justice of the Republic of Uzbekistan on March 30, 2021, account
number 8] These sanitary rules, norms and hygiene regulations (hereinafter - sanitary rules)
medical organizations adapted to the treatment of COVID-19 infection and classification
determines sanitary-hygiene and anti-epidemic measures to prevent infections.
2019 coronavirus infection (COVID-19) is an infectious disease caused by SARS-CoV-2, the
severe acute respiratory syndrome coronavirus 2. The disease was first identified in Wuhan,
China in 2019 and spread globally, causing the 2019-2020 coronavirus pandemic. The disease
causes symptoms such as high fever, cough, and difficulty breathing. In some cases, muscle pain,
phlegm, and sore throat are observed. Although most people infected with the virus develop mild
symptoms, in some patients the disease can lead to severe pneumonia and multiple organ
failure. Among diagnosed cases, the mortality rate is on average 3.4 percent. Among people
under 20 years old, this indicator is 0.2 percent, among people over 80 years old it is 15 percent.
The virus is a type of disease that spreads from person to person through droplets produced when
coughing and sneezing, similar to the flu. Although the virus is most contagious when a patient
develops symptoms, it can be transmitted to others before symptoms appear. Symptoms usually
appear within five days, but this period can last from 2 to 14 days. The main symptoms of the
disease are fever, cough and shortness of breath. The disease can cause pneumonia and acute
respiratory distress syndrome in the patient. There is currently no vaccine or medication for
COVID-19. Disease management consists of symptomatic treatment and supportive therapy. To
prevent the spread of the disease, it is recommended to wash hands, cover your mouth when you
cough, and keep a distance from others (especially those who are not feeling well). Individuals
suspected of having the virus are advised to self-isolate for 14 days. The pandemic has caused a
number of socio-economic challenges globally, leading to the postponement or cancellation of
sports and cultural events, and concerns about shortages of medicine, electronics, and food.
information and conspiracy theories were published, cases of xenophobia and racism were
observed in various countries, and panicked consumers were observed to buy goods such as
toilet paper in large quantities. In July 2021, WHO Chairman Tedros Adhanom Ghebreyesus
said that a vaccine-resistant strain of the coronavirus may appear as a result of vaccinations. In
the treatment of patients suffering from corona virus disease, the use of anticoagulants is the
main part of the standard of treatment. Patients suffering from coronavirus disease are treated in
our center. In addition to the treatment of these patients, the effectiveness of the treatment is also
checked and conclusions are drawn accordingly. During the treatment and observation, we
witnessed that their coagulation system is damaged despite the use of a number of anticoagulants.
That is, it was felt that anticoagulants did not work after 7-8 days or their effect was insufficient,
and this situation is reflected in the analyses. After conducting observations in several patients,
we worked on how to use anticoagulant therapy more effectively and determined the optimal
methods of using anticoagulants. we tried Despite the fact that some patients received low-
molecular-weight heparin, some high-molecular-weight heparin, and some revoroxaban (or
Xarelta) during the treatment, the results of the analysis showed that after a few days (on average,
7 days in patients taking these drugs) it was noticed that the coagulation system indicators were
changing towards coagulation instead of changing according to blood thinning. In the words of
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doctors, the analysis showed that the drugs were not working. This made me think about how to
influence the anticoagulant system in the treatment of patients. We obtained the following results
for a total of 120 patients in 10 to 12 groups, using 3 groups of drugs. We conditionally divided
the patients into 4 groups according to which group of drugs we use.
o group receiving low molecular weight heparin
o Revoroxaban group
3 groups of drugs were administered to the group with periodic replacement
(anticoagulants of the 1st group on 6-7 days, and anticoagulants of the 3rd group from the
7-8th day).
The disease COVID-19 causes changes in blood coagulation in many patients, which
increases the risk of thrombotic events. Anticoagulants, such as low molecular weight
heparins, play an important role in the prevention and treatment of thrombosis.
Duration of treatment with anticoagulants
1. Prophylactic treatment: In severe forms of COVID-19, anticoagulants are usually started in the
early stages of the disease and continued until the patient's condition improves.
2. Therapeutic treatment: anticoagulants are used in a therapeutic dose in patients with signs of
thrombosis. Duration of treatment is determined depending on the clinical condition of the
patient.
3. Monitoring and evaluation: Coagulation parameters (eg, PT, APTT) should be monitored
regularly during anticoagulant therapy. This helps to determine the correct dosage of the drug
and prevent side effects.
Risks and Precautions:
the risk of bleeding may increase during treatment with anticoagulants. Therefore, it is necessary
to carefully monitor patients and determine the dose of the drug individually.
Anticoagulant treatment of patients with COVID-19 is an effective method for prevention and
treatment of thrombosis, the duration of which is determined by the clinical condition of the
patient. Regular monitoring and individual approach by medical professionals is necessary.
Future studies are expected to provide additional information in this area.
COVID‐19, thrombosis and anticoagulants. The SARS‐CoV‐2 virus enters the lungs and attaches
to the ACE receptor in the alveoli of pneumocyte cells, triggering immune cells from the arteries
and producing cytokines and chemokines. As a result, immune cells enter the alveoli from the
blood and activate macrophages and neutrophils in the alveolar space. UFH, with
anti‐inflammatory properties, can inhibit cytokines and chemokines. As a result, immune cells
are prevented from entering the alveoli. Aspirin can also prevent the aggregation of platelets and
neutrophils by inhibiting IL‐6. FXa converts prothrombin to thrombin, and AT can block this
path. Thrombin can also convert fibrinogen to fibrin. Accumulation of fibrins and blood cells
cause thrombosis ATIII can inhibit the thrombosis process. Finally, thrombosis causes MOF.
Thrombotic heart damage includes DIC, MI, and VTE. The lungs can develop ARDS, ALI, PE,
and PTE. Kidney damage includes AKI and ESRD. Stroke is a complication of thrombosis in the
brain. ACE, angiotensin‐converting enzyme; AKI, acute kidney injury; ALI, acute lung injury;
ARDS, acute respiratory distress syndrome; AT, antithrombin; COVID‐19, coronavirus disease
2019; DIC, disseminated intravascular coagulation; ESRD, end‐stage renal disease; FXa, Factor
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Xa; MI, myocardial infarction; MOF, multiple organ failure; PE, pulmonary embolism; PTE,
pulmonary thromboendarterectomy; SARS‐CoV‐2, severe acute respiratory syndrome
coronavirus 2; UFH, unfractionated heparin; VTE, venous thromboembolism. In patients with
COVID‐19, the increasing levels of D‐dimer, a soluble fibrin breakdown product produced when
the fibrinolytic system breaks down thrombi in an organized manner, can be related to several
factors, such as the life cycle of the virus. Another hypothesis in these patients with COVID‐19
is the inflammatory responses to viral infection and the dysfunction of endothelial cells with
thromboembolic complications. We should also consider that a direct consequence of acute lung
injury as seen in COVID‐19 infection. As far as we know, until now, there are no completed
randomized clinical trials (RCTs) investigating the best anticoagulant choice and treatment
timing, duration, and dosage in patients with COVID‐19. They are all in progress. Plus, various
guidelines regarding the management of patients with COVID‐19 have been proposed by various
international organizations, yet most of them do not comment on anticoagulation strategies.
These guidelines are based merely on consensus statements and expert views. They also have
some limitations. For instance, they recognize SARs‐COV2 as a cause of microthrombi, which
worsens the prognosis of patients; however, they cannot propose appropriate guidelines or
consensus statements to address this issue. Moreover, they suggest therapeutic doses of heparin
for diagnosed or highly suspected macro‐thrombotic events, like PE and deep vein thrombosis
(DVT), although they miss the subject of undiagnosable micro‐thrombotic events. Finally, no
distinct scoring system for measuring VTE risk on admission is specific to SARs‐CoV‐2. For
hospitalized patients with COVID‐19 with a more than normal upper limit D‐dimer level, in need
of low‐flow oxygen, and with no elevated bleeding risk, heparin (in therapeutic doses),
especially low‐molecular‐weight heparin (LMWH), has been recommended by the US National
Institutes of Health (NIH) and many other trials. The ideal thrombophylactic regimen in patients
with COVID‐19 is not yet understood. During the SARS‐CoV‐2 infection, anticoagulation can
be attained by intravenous (i.v.) or oral anticoagulants. Although some antiviral agents used to
treat SARS‐CoV‐2 infections interact with oral anticoagulants, such as anti‐factor Xa (e.g.,
rivaroxaban and apixaban), heparin rarely demonstrates such interactions.Moreover, these oral
agents are highly susceptible to metabolic changes in the div during critical or acute phases of
the disease because their metabolism and serum levels are affected, leading to uncontrolled
bleeding or thrombosis.Among the different types of I.V. anticoagulants, UFH is the only agent
requiring frequent laboratory monitoring. However, UFH is more affordable, has a shorter
half‐life, and can be easily excreted from the div, even in those with renal dysfunction, obesity,
and other critical conditions.In addition, the anti‐inflammatory effects of UFH can be beneficial
in alleviating the inflammatory processes of COVID‐19, such as the associated COVID‐19
CSS.Interestingly, LMWH has less direct antiviral activity due to the shorter duration of
competitive spike protein binding than UFH. Nevertheless, LMWH might be preferred to UFH
due to several reports of heparin resistance in patients with COVID‐19, the lower risk of
bleeding and dose‐dependent plasma levels, and a longer half‐life. In patients with COVID‐19
with a history of heparin‐induced thrombocytopenia (HIT), activated factor X (Xa) inhibitors,
like fondaparinux, could be administered as an alternative. Due to the occurrence of
coagulopathy in ARDS, which might be limited to the lungs, it has been hypothesized that
nebulized anticoagulation might be the best approach. However, previous reports have not
shown the clinical benefit of this route of administration, but there is a need for further
studies.Furthermore, although UFH is the drug of choice in any trimester of pregnancy, LMWH
is the best option for postpartum patients.In conditions where anticoagulants are contraindicated
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or unavailable, mechanical thromboprophylaxis, such as pneumatic compression devices, should
be considered. However, applying mechanical and pharmacological thromboprophylaxis for
critically ill patients with COVID‐19 might lead to better outcomes if not contraindicated.
Conversely, anticoagulation therapy is not beneficial in outpatient settings, as it has not been
associated with an improved prognosis.Nonetheless, there are conditions where anticoagulation
therapy would appear necessary, such as immediately following discharge from the hospital. In
the form of symptoms of the disease, in most cases the following are observed:
increase in div temperature (83-99%),
cough (59−82%),
general weakness (44−70%),
loss of appetite (40-84%),
shortness of breath, lack of breath (31−40%),
muscle pain (11-35%).
Other symptoms include sore throat, runny nose, headache, diarrhea, nausea, and vomiting, as
well as loss of smell and taste.
In elderly people and immunocompromised people, the following can be observed: an atypical
process without fever, general weakness, decreased concentration and physical activity, diarrhea,
loss of appetite, and the development of delirium (loss of mental clarity).
According to the document, fever and cough are less common in children than in adults.
In general, the guide mentions the following mild symptoms of the disease:
an increase in div temperature to 38 degrees (or the disease passes without an increase in
temperature),
increased sweating,
general weakness,
cough
anxiety,
sore throat,
dry throat, nausea,
vomiting or diarrhea
myalgia and div aches,
headache,
loss of sense of taste and smell.
In the document, doctors recommended symptomatic treatment at home for patients with mild
COVID-19:
antipyretic and painkillers (for example, paracetamol, ibuprofen);
complex therapy for the treatment of rhinitis and nasopharyngitis (moisturizers, nasal drops);
complex treatment of bronchitis (antitussives, broncholytic agents and other drugs);
drinking hot liquids frequently to loosen phlegm, moisten mucous membranes, and maintain
water balance. What should be done to prevent infection?
There are four precautions you and your family can take to prevent infection:
Washing hands frequently with alcohol-based hand sanitizers or soap.
When coughing or gagging, cover your mouth and nose with a bent elbow or a tissue, then
dispose of the tissue in a closed trash can.
Avoid close contact with anyone who has symptoms of a cold or fever.
If you or your child has a fever, cough, or shortness of breath, seek medical attention as soon as
possible. Given the unpredictable nature of the virus and the duration of its spread, UNICEF is
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working with governments, the World Health Organization and other partners in emergency
situations in regions, especially in countries with weak health systems and limited capacity to
deal with the main outbreaks of the disease. is developing action plans.
On February 17, UNICEF appealed for $42.3 million to support efforts to prevent the spread of
the COVID-19 virus. The initial funding will be used to help children, pregnant women and their
families know where to get help and prevent the spread of COVID-19, as well as efforts to
prevent the spread of misinformation.
References and references:
1. https://uz.m.wikipedia.org/w/index.php?title=COVID-19_pandemiyasi&wprov=rarw1
2. Sanitary rules, norms and hygiene regulations for the prevention of infections in medical
organizations adapted to the treatment of COVID-19 infection. 2021
3. NEW PRINCIPLES OF ANTICOAGULANT THERAPY IN PATIENTS WITH COVID-19
Authors I. E. Irgashev
4.
https://yuz.uz/uz/news/covid-19ni-davulashda-kandayi-dori-darmonas-kolaridad
