Corona virus disease. Discovering the ‘perfect storm’ that increases the risk of developing blood clots

Two Italian studies, conducted by a group of researchers from Sapienza University in Rome, identified a combination of factors to identify those infected with the Covid virus who are at greater risk of developing thrombosis and indications for improving anticoagulant therapy. About 20% of Covid-19 patients are at risk of developing a blood clot during hospitalization. The first study Posted in coagulation and thrombosisand the second is being published in the blood.

March 25 – In patients with COVID-19, one of the main causes of death is a high risk of thrombosis, which can occur both in the venous region in the form of a deep vein thrombosis or pulmonary embolism, and in the arterial region in the form of a myocardial infarction or stroke. About 20% of Covid-19 patients can develop this serious complication while in hospital. To date, the available evidence has not made it possible to clearly identify Covid-19 patients at risk of thrombosis or indications for anticoagulant therapy to prevent thromboembolic risk, but two Italian studies have now been clarified.

Italian search groupin coordination Francesco Violi Department of Internal Medicine and Medical Specialties at the Sapienza University of Rome, in collaboration with Lorenzo Loveredo, Pasquale Bignatellin another meaning Anarita Vestry From the same university, two studies were conducted in which patients at greatest risk of thrombosis and who represent optimal doses of anticoagulant therapy for the prevention of thrombotic events were identified. One of these two works was published in the magazine coagulation and thrombosis The other is posted on the blood.

In particular, he explains a note from Ateneto, the first work It consisted of a multicenter study of 674 patients with COVID-19, in which 3 simple variables such as age, serum albumin and levels of D-dimer, a fragment of the fibrin protein, responsible for the formation of clots (thrombosis) were combined. ) in the blood vessels, it has allowed to identify patients most at risk of developing thrombosis.

It was found that those with a combination of elderly (over 70 years) low albumin (<35 جم / لتر) و D-dimer مرتفع (> 2000 ng/ml) were more likely to develop thrombosis than older patients. And with normal values ​​for albumin and D-dimer.

“With the availability of this simple result, called the ADA score – Francesco Violi explains – it is now possible to determine who is most at risk of developing a clot and who needs anticoagulant therapy.”

second job, Posted in the blood, the official journal of the European Society of Hematology, responds to a problem still under debate two years after the start of the pandemic, which is whether these thrombotic events should be prevented with standard anticoagulant therapy or with prophylactic doses, i.e. low doses of anticoagulants. This aspect is important because low doses of anticoagulants, which are still the most widely used treatment to this day, may be insufficient to reduce the risk of thrombosis.

The team of researchers conducted a meta-analysis of studies comparing the two types of treatment, and showed that standard doses of anticoagulants are superior to prophylactic doses in reducing thrombotic events without increasing the risk of dangerous bleeding.

“The meta-analysis, which included about 4,500 patients with COVID-19 – concludes Violi – shows how this therapy will represent a useful support not only for reducing thrombotic events, but also for mortality, which, unfortunately, remains high among these people.”

25 March 2022
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