Features of various options for anticoagulant therapy for a new coronavirus infection against the background of obesity
- Authors: Kalinin R.E.1, Suchkov I.A.1, Agapov A.B.1,2, Povarov V.O.1, Mzhavanadze N.D.1,3
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Affiliations:
- Ryazan State Medical University named after I.P. Pavlov
- Regional Clinical Hospital
- City Clinical Hospital of Emergency Medical Care
- Issue: Vol 105, No 1 (2024)
- Pages: 14-25
- Section: Theoretical and clinical medicine
- URL: https://kazanmedjournal.ru/kazanmedj/article/view/159398
- DOI: https://doi.org/10.17816/KMJ159398
- ID: 159398
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Abstract
BACKGROUND: When treating a new coronavirus infection, the prevention of venous thromboembolic complications in obese patients is of particular importance.
AIM: To analyze various options for anticoagulant therapy in obese and non-obese patients in the treatment of a new coronavirus infection.
MATERIAL AND METHODS: The patients were divided into two groups: the first group — obese patients — 151 (40.8%) people [average age 63 (56–69) years], the second group without obesity — 219 (59.2%) people [average age 63 (51.5–71.0) years], p=0.998. According to the prescribed anticoagulant and the presence of obesity, patients were divided into subgroups: subgroup 1 — non-obese + low-molecular-weight heparin (n=114), subgroup 2 — non-obese + unfractionated heparin (n=58), subgroup 3 — obesity + low-molecular-weight heparin (n=76), subgroup 4 — obesity + unfractionated heparin (n=66). Venous thrombotic complications and bleeding rates were assessed. Analysis of qualitative indicators was performed using Pearson χ2 and Fisher tests. The distribution of quantitative indicators was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests (p >0.05). Due to the non-normal distribution of indicators, mean values were presented as median (Me) and interquartile range (Q1–Q3), and analysis was carried out using Wilcoxon, Mann–Whitney and Kruskal–Wallis tests.
RESULTS: In nonobese patients, a comparable incidence of deep vein thrombosis was noted on low molecular weight heparin and unfractionated heparin — 1 (0.9%) case versus 3 (5.2%) cases (p=0.102). At the same time, there was a statistically significant difference in the frequency of pulmonary embolism without a source according to autopsy data — 2 (1.8%) versus 4 (6.9%) cases (p=0.004). In obese patients receiving unfractionated heparin, the incidence of this complication was higher and amounted to 9 (13.6%), and in patients receiving low molecular weight heparin — 2 (2.6%) cases (p=0.004). A higher incidence of bleeding was observed in patients with obesity compared to patients without it (10.6 vs 4.7% of cases, p=0.045). When analyzing hemorrhagic complications, it was found that the incidence of major and significant bleeding was higher in patients receiving unfractionated heparin rather than low molecular weight heparin (16.7 vs 5.3% of cases, p <0.001).
CONCLUSION: The use of low molecular weight heparin in obese patients with new coronavirus infection was associated with a low incidence of pulmonary embolism and bleeding compared with patients receiving unfractionated heparin.
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About the authors
Roman E. Kalinin
Ryazan State Medical University named after I.P. Pavlov
Email: kalinin-re@yandex.ru
ORCID iD: 0000-0002-0817-9573
SPIN-code: 5009-2318
M.D., D. Sci. (Med.), Prof., Head of Depart., Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics
Russian Federation, Ryazan, RussiaIgor A. Suchkov
Ryazan State Medical University named after I.P. Pavlov
Author for correspondence.
Email: suchkov_med@mail.ru
ORCID iD: 0000-0002-1292-5452
SPIN-code: 6473-8662
M.D., D. Sci. (Med.), Prof., Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics
Russian Federation, Ryazan, RussiaAndrey B. Agapov
Ryazan State Medical University named after I.P. Pavlov; Regional Clinical Hospital
Email: agapchik2008@yandex.ru
ORCID iD: 0000-0003-0178-1649
M.D., Cand. Sci. (Med.), Department of Vascular Surgery, Regional Clinical Hospital; Researcher, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics
Russian Federation, Ryazan, Russia; Ryazan, RussiaVladislav O. Povarov
Ryazan State Medical University named after I.P. Pavlov
Email: povarov.vladislav@mail.ru
ORCID iD: 0000-0001-8810-9518
SPIN-code: 2873-1391
M.D., Cand. Sci. (Med.), Assistant, Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics
Russian Federation, Ryazan, RussiaNina D. Mzhavanadze
Ryazan State Medical University named after I.P. Pavlov; City Clinical Hospital of Emergency Medical Care
Email: nina_mzhavanadze@mail.ru
ORCID iD: 0000-0001-5437-1112
SPIN-code: 7757-8854
ResearcherId: M-1732-2016
M.D., D. Sci. (Med.), Prof., Depart. of Cardiovascular, X-ray Endovascular Surgery and Radiation Diagnostics
Russian Federation, Ryazan, Russia; Ryazan, RussiaReferences
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