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2 . 2024

Prognostic value of standard coagulogram indicators for assessing the risk of thrombosis in pregnant women with coronavirus infection

Abstract

Pregnant women infected with SARS-CoV-2 should be considered at high-risk group of severe morbidity and mortality, including the risk of thrombosis.

The aim of the study was to identify daily changes in standard coagulogram parameters in order to assess the prognostic significance of the risk of thrombotic complications in pregnant women with SARS-CoV-2.

Study subject: standard coagulogram parameters of pregnant patients with a new coronavirus infection.

Material and methods. Retrospective analysis of data from 230 case histories of pregnant women with coronavirus infection who underwent inpatient care at the State Budgetary Healthcare Institution «Samara Regional Clinical Hospital named after V.D. Seredavin» in 2021. According to the eligibility criteria, 99 case histories of women in the III trimester of pregnancy with infection verified with PCR-test were selected. Thrombosis developed in 5 patients (study group), 94 women (control group) suffered an infection without developing thrombosis. A comparative analysis of coagulogram data in the study groups and a correlation analysis of the identified changes with the day of illness and the moment of blood clot organization were carried out.

Results. Prothrombin time (PT) in patients with thrombosis was higher (p<0.001), the interquartile range of aPTT (activated partial thromboplastin time) was supernormal (Me 36.10 [Q1–Q3 30.10–44.50] sec). Quick PT and fibrinogen levels were lower (p<0.001) in the group of women without thrombosis. In women with thrombosis, hypofibrinogenemia was recorded on days 12–15 of the disease (Me 2.52 [Q1–Q3 1.96–3.25] g/l); by the period of 16–23 days: INR (international normalized ratio) and prothrombin time values reached their maximum (Me 1.22 [Q1–Q3 1.08–1.39] p<0.001 and Me 13.50 [Q1–Q3 11.70–15.80] sec, p<0.001, respectively), the lowest prothrombin values according to Quick PT (Me 68.20 [Q1–Q3 56.90–82.50] %) and an expressed decrease in fibrinogen levels were observed (Me 1.20 [Q1–Q3 0.71–2.48] g/l). After 24 days of illness, INR values decreased (Me 1.20 [Q1–Q3 1.09–1.33], p<0.004); the maximum median values were achieved at aPTT (Me 38.00 [Q1–Q3 34.10–46.90] sec), and Quick PT increased slightly (Me 69.05 [Q1–Q3 63.43-85.60] %) and fibrinogen levels returned to normal values (Me 3.87 [Q1–Q3 3.54–4.36] g/l).

In pregnant women with thrombosis, correlations with the day of the disease were revealed: INR (r=0.327, p=0.006), prothrombin time (r=0.310, p=0.010), fibrinogen levels (r=0.243, p<0.071) and Quick PT (r=-0.252, p=0.037). In pregnant women without thrombosis, correlations with the day of illness were revealed in: INR (r=0.164, p=0.009), prothrombin time (r=0.155, p=0.016), aPTT (r=-0.295, p<0.001).

Conclusion. In patients with thrombosis in the period from the 16th to the 23rd day of the disease, corresponding to the occurrence of thrombotic complications, a state of hypocoagulation was recorded according to a standard coagulogram. However, despite the hypocoagulation achieved during heparin therapy, thrombosis still occurred. For this reason, the use of a coagulogram to predict the development of thrombosis during coronavirus infection that occurs during pregnancy is not effective.

Keywords:coronavirus infection; pregnancy; coagulogram; thrombosis

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

Сontribution. All authors contributed equally to the writing and preparation of the manuscript. All authors read and approved the final version of the manuscript.

For citation: Spiridonova N.V., Gritcenko T.A., Khurtova E.F. Prognostic value of standard coagulogram indicators for assessing the risk of thrombosis in pregnant women with coronavirus infection. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2024; 12 (2): 50–8. DOI: https://doi.org/10.33029/2303-9698-2024-12-2-50-58 (in Russian)

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CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Institute in the Russian People?s Friendship University named after P. Lumumbа

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