Acute Thrombosis of Lower Extremities Veins in Surgical Patients With COVID-19

   AIM OF THE STUDY. To establish the incidence of acute thrombosis of the veins of the lower extremities and the activity of the most significant trigger agents that led to this complication in patients with a new coronavirus infection.

   MATERIAL AND METHODS. The clinical section of the work is presented by observations of 123 patients with acute surgical pathology and thrombosis of the veins of the lower extremities. The first group (comparison) (n = 48) included patients with thrombosis of the veins of the lower extremities, the second (studied) group (n = 87) included patients with a similar problem that arose against the background of coronavirus infection. All patients underwent surgical interventions: thrombectomy and plication. Before surgery, on the 1st, 4th and 7th days after surgery, disorders of the hemostasis system, the severity of endogenous intoxication syndrome, and lipid metabolism were assessed.

   RESULTS. Damage to the veins of the lower extremities in patients with acute surgical pathology and new coronavirus infection occurs much more often, in 8.04 % of cases, than in such patients without COVID-19, in 0.76% (χ² = 252.5, p < 0.001). Of the 87 patients with acute venous thrombosis of the inferior vena cava system and COVID-19, 63 patients (72.41 %) were operated on. In the early postoperative period, venous rethmbosis occurred in 11 (17.5 %) patients. The mortality rate was 6.3 %. According to thromboelastography, in the main group the values of such parameters as reactive time, the growth rate of the fibrin network and its structure formation and the maximum strength of the clot were statistically significantly higher than in the control group, which indicates the predominance of hypercoagulation in these patients. Patients in this group showed more significant phenomena of endotoxemia, oxidative stress and activation of phospholipases.

   CONCLUSION. With a new coronavirus infection, surgical patients have a high probability of developing threatening thrombohemorrhagic complications. The most important trigger for their occurrence is significant disturbances in the hemostatic system, which are generally characterized by an increased ability of the blood to form thrombosis against the background of a decrease in its fibrinolytic activity. Disturbances in the hemostatic system occurred against the background of oxidative stress, activation of phospholipases and endotoxemia. The obtained material is proof of the significance of the new coronavirus COVID-19 infection worsens coagulopathy, which plays an important role in the pathogenesis of the disease in general and the development of complications.

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