INFLUENCE OF PLASMA HEMOSTASIS ON ENDOTHELIAL FUNCTION IN PATIENTS WITH CHRONIC CORONARY HEART DISEASE AND COVID-19
DOI:
https://doi.org/10.32782/eddiscourses/2024-4-16Keywords:
chronic coronary heart disease, COVID-19, endothelial dysfunction, plasma hemostasisAbstract
Actuality. Coronavirus disease COVID-19 impairs plasma hemostasis and endothelial function (EF), which increase the risk of thromboembolic complications and cardiovascular mortality. A promising task is to study the relationship between EF and plasma hemostasis (PH) in patients with coronary heart disease (CHD) in combination with COVID-19. The purpose of the article: to investigate the impact of COVID-19 on the interdependence of changes in the PG and EF systems in patients with CHD. Research methods: The laboratory and instrumental results of 384 patients were analyzed, who were divided into 3 groups: Group 1 – CHD without COVID-19 (n = 79); Group 2 – CHD in combination with COVID-19 (n = 127); Group 3 – COVID-19 without CHD (n = 180). The control group included 30 conditionally healthy individuals. Changes in plasma hemostasis were studied using an automatic blood coagulation analyzer K 3002 OPTIS (KSELMED, Poland): Thrombin time, APTT, prothrombin time, INR, XIIa-dependent fibrinolysis, RFMK, fibrinogen, protein C, Antithrombin III. Circulating endothelial cells by the method of Hladovits in the modification of Sivak V.V. Ristomycin-cofactor activity of von Willebrand factor. Zellermeier Sorensen test (on the hardware complex HDI 11XE Philips, as well as ESAOTE MyLabXE8 XP). Main material. In patients with CHD with concomitant COVID-19, a wide range of disorders of the functional state of plasma hemostasis was observed, in particular, an increase in the level of RFMC, XIIa-dependent fibrinolysis, as well as a decrease in Protein C and antithrombin III. The profile of CHD in combination with COVID-19, in contrast to the “isolated” course of both conditions, was characterized by a decrease in vascular reactivity according to the Zellermeier test. Patients with chronic coronary artery disease, in particular in its combination with COVID-19, showed signs of endothelial dysfunction according to humoral markers: von Willebrand factor and circulating plasma endothelial cells. Among patients with coronary artery disease with COVID-19, the international normalized ratio is directly related to endothelial function. Endothelium-dependent vasodilation was directly related to thrombin time. Endothelium-independent vasodilation had a direct effect on RFMC. In the control group, there were no significant relationships between EF and PG indices. Plasma hemostasis had the greatest effect on endothelial function in the group of patients with COVID-19 without CHD. Conclusion. Patients with chronic coronary artery disease and concomitant COVID-19 along with dysfunction of the plasma hemostasis system showed signs of endothelial dysfunction. Additional consideration of the characteristics of plasma hemostasis and endothelial function is advisable in the management of such patients.
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