asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2021-18-2asurgery-240Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYЭффективность и безопасность применения антитромботической терапии при COVID-19The effectiveness and safety of the use of antithrombotic therapy in COVID-19https://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, кандидат медицинских наук, доцент кафедры общей хирургии лечебного факультета 

117997, Москва, ул. Островитянова, д. 1

Kirill V. Lobastov, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery of the Faculty of General Medicine 

1, Ostrovityanov St., Moscow, 117997

lobastov_kv@mail.ruhttps://orcid.org/0000-0003-3537-7409ПорембскаяО. Я.PorembskayO. Ya.

Порембская Ольга Ярославна, кандидат медицинских наук, ассистент кафедры сердечно-сосудистой хирургии 

191015, Санкт-Петербург, ул. Кирочная, д. 41

Olga Ya. Porembskaya, Cand. Sci. (Med.), Assistant of the Department of Cardiovascular Surgery 

41, Kirochnaya St., St Petersburg, 191015

porembskaya@yandex.ruhttps://orcid.org/0000-0002-1306-1502СчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович, кандидат медицинских наук, доцент кафедры общей хирургии лечебного факультета 

117997, Москва, ул. Островитянова, д. 1

Ilya V. Schastlivtsev, Cand. Sci. (Med.), Associate Professor, Department of General Surgery, Faculty of General Medicine 

1, Ostrovityanov St., Moscow, 117997

Schastlivtsev.ilya@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияMechnikov North-Western State Medical UniversityRussian Federation2021250620211821730Copyright © Лобастов К.В., Порембская О.Я., Счастливцев И.В., 20212021Лобастов К.В., Порембская О.Я., Счастливцев И.В.Lobastov K.V., Porembskay O.Y., Schastlivtsev I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/240

Статья представляет собой несистематический обзор литературы, затрагивающий вопросы эффективности, безопасности и целесообразности применения антитромботических средств при COVID-19 у пациентов, находящихся на лечении в различных условиях: на госпитальном этапе, включая отделение реанимации и интенсивной терапии, на амбулаторном этапе после выписки из стационара, при первичном амбулаторном лечении. Затрагиваются вопросы тромботических осложнений при вакцинации и необходимости их предотвращения. Проведенные исследования подтверждают важность применения профилактических доз антикоагулянтов у всех госпитализированных больных. Использование повышенных доз оказалось неэффективным у лиц с тяжелым течением заболевания, находящихся на лечении в реанимации. При инфекции средней тяжести имеется очевидная польза от применения повышенных доз антикоагулянтов в виде снижения риска органной недостаточности, однако формулирование окончательных выводов возможно только после публикации финальных результатов исследований. Продленная фармакологическая профилактика после выписки из стационара может быть полезна отдельным пациентам, однако общий риск развития тромботических осложнений в отдаленном периоде не представляется высоким. Имеющиеся данные не поддерживают применение антикоагулянтов при лечении коронавирусного заболевания в амбулаторных условиях, так как риск развития тромботических осложнений у таких пациентов не увеличен, а безопасность применения антикоагулянтов не оценена. Сулодексид может быть полезен отдельным амбулаторным больным с повышенным риском прогрессирования заболевания. Вакцинация может провоцировать развитие тромбоза атипичной локализации по иммунным механизмам, однако риск подобных осложнений ниже при самом коронавирусном заболевании. Антикоагулянтная профилактика при введении вакцины не показана.

The article is a non-systematic review of the literature, addressing the effectiveness, safety and appropriateness of antithrombotic drugs for COVID-19 in patients undergoing treatment in different settings: in the hospital phase, including the intensive care unit, in the outpatient phase after discharge from hospital, in primary outpatient treatment. The issues of thrombotic complications during vaccination and the necessity of their prevention are discussed. The studies confirm the importance of prophylactic doses of anticoagulants in all hospitalized patients. The use of increased doses has proven ineffective in patients with a severe course of the disease who are being treated in the intensive care unit. In moderately severe infections, there is a clear benefit of increased doses of anticoagulants in reducing the risk of organ failure, but definitive conclusions can only be drawn after the final results of the studies have been published. Prolonged pharmacological prophylaxis after hospital discharge may be useful in individual patients, but the overall risk of thrombotic complications in the long-term period does not appear to be high. The available data do not support the use of anticoagulants in the treatment of coronavirus disease in the outpatient settings, since the risk of thrombotic complications is not increased in such patients, and the safety of anticoagulant use has not been evaluated. Sulodexide may be useful in selected outpatients at increased risk of disease progression. Vaccination may provoke the development of atypical localized thrombosis by immune mechanisms, but the risk of such complications is lower in the coronavirus disease itself. Anticoagulant prophylaxis during vaccine administration is not indicated.

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The authors declare that there are no conflicts of interest present.