Тo the issue regarding the state of the coagulation system in patients with СOVID-19 operated with emergency abdominal surgical pathology of different age groups

Abstract

The article investigates the state of anticoagulant and fibrinolytic activity of blood in patients undergoing urgent abdominal surgery during the COVID-19 pandemic and assesses the risk of venous thromboembolic complications. Objective — to examine the anticoagulant and fibrinolytic activity of blood in patients with COVID-19 undergoing urgent abdominal surgery of different age groups. Materials and Methods. A single-center retrospective study of 238 medical records of inpatients was conducted and analyzed by total sampling for the period from April 2020 to April 2022. There were 245 urgent interventions performed: acute appendicitis — 20.4%, bowel obstruction — 19.6%, acute cholecystitis — 17.8%, hollow-organ perforation — 12.6%, strangulated hernia — 10.2%, acute pancreatitis — 3.2%, other acute surgical pathology — 5.7%, and abdominal trauma — 10.5%. The state of the blood coagulation system was assessed by the activity of antithrombin III, protein C. We studied the ratio of plasmin to plasminogen, euglobulin lysis, Hageman-dependent fibrinolysis, spontaneous blood lysis. And fibrinogen level were determined. Results and Discussion. It was found that the lysis of blood plasma euglobulins in long-livers led to inhibition of enzymatic fibrinolysis due to an increase in the number of plasmin inhibitors. Changes in physiologic lysis in the elderly and long-lived patients indicated its activation, which was significantly different from the indicators of urgently operated patients with COVID-19 in the control group. The state of the anticoagulant system was significantly reduced in long-livers, as indicated by the low antithrombin III activity. It was found that a decrease in protein C activity with a simultaneous decrease in antithrombin III significantly increases the thrombophilic potential in urgently operated patients and COVID-19 patients.