Hemostasis characteristics in patients with coronavirus disease 2019 and various forms of acute coronary syndrome

Aim.  To evaluate individual hemostasis parameters in severe coronavirus disease 2019 (COVID-19) and various forms of acute coronary syndrome (ACS). Material and methods.  The study included 104 patients with severe COVID-19 and ACS who did not take anticoagulants prehospitally: group 1 (n=35) — with unstable angina; group 2 (n=34) — with non-ST-elevation myocardial infarction; group 3 (n=35) — with ST-elevation myocardial infarction (STEMI). The parameters of the coagulation system were studied, including the rotational thromboelastometry (ROTEM) for the extrinsic (EXTEM) and intrinsic (INTEM) activation pathways. Results.  D-dimer values were recorded from 0,30 to 13,90 μg/ml and were elevated in 100% of cases in group 1, in 91% in group 2, and in 94% in group 3, with medians of 4,80, 2,65, and 1,62, respectively (p K-W <0,001). Fibrinogen levels ranged from 1,10 to 11,10 g/l and were elevated in 88% of patients in group 1, in 79% in group 2, and in 62% in group 3, with medians of 4,90, 5,50, and 4,61, respectively (p K-W =0,015). There were no group 1 patients with fibrinogen levels below reference, while in group 2 and 3, it was 2,9% and 5,7%, respectively. Thrombin time and prothrombin time values were elevated in more than half of the patients, differing significantly in absolute values (p=0,011 and p=0,029, respectively). Activated partial prothrombin time was above normal in 89% of patients in group 3 and 100% in groups 1 and 2 (p=0,017). According to ROTEM, clotting time was increased; INTEM by group — from 247,00 s to 309,00 s (p<0,001); maximum clot density was decreased — INTEM, p=0,003; EXTEM, p=0,005. Conclusion.  In patients with severe COVID-19 and ACS, coagulation system parameters are characterized by significant heterogeneity. Elevated D-dimer and fibrinogen levels are recorded in all ACS variants. ROTEM values are consistent with hypocoagulation. In patients with STEMI, the most pronounced parameters were increased clotting time (INTEM) and decreased clot density (INTEM, EXTEM).