COVID-19: the efficacy and safety of anticoagulant, glucocorticosteroid therapy and metabolic

Abstract

Objective: assessment of the efficacy and safety of the use of anticoagulant, glucocorticosteroid, metabolic therapy in patients with COVID-19 at the inpatient stage of treatment.

Material and methods. In February 2021, a prospective, randomized, single-center, continuous comparative study was organized on the basis of the Gomel City Clinical Hospital No. 3, which included 827 patients with moderate and severe clinical course of COVID-19.

Results. Stratification of the risks of an unfavorable outcome in patients with moderate and severe clinical course of COVID-19 made it possible to optimize treatment, with the selection of optimal doses of anticoagulant and glucocorticosteroid therapy, which led to an increase in patient survival. A high level of blood lactate reflects the degree of damage to the lung tissue, the severity of the course of the disease and requires an increase in the dose of anticoagulant therapy. The use of thiotriazoline effectively reduces the level of lactate, which makes it possible to restore the energy balance of the cell.

Conclusion. The use of therapeutic (intermediate) doses of anticoagulant and optimal glucorticosteroid therapy in patients at high risk of poor outcomes with moderate and severe clinical course of COVID-19, can increase the survival rate from 82.1 to 96.8%, p<0.0001. The appointment of anticoagulant therapy was complicated by “minor” bleeding in 2.13% in the main group, in 2.11% in the control group, p>0.05, and the use of glucocorticosteroids was complicated by newly diagnosed diabetes mellitus (2.13% in the main group, 1.81% in the control group, p>0.05), which allows us to consider the therapy used is safe. The use of the metabolic, antioxidant agent thiotriazoline in patients with an LDH level of more than 800 U/L and with a high risk of an unfavorable outcome led to a decrease in LDH within five days of treatment by 447.9 U/L in the main group compared with the control group by 124.0 U/L (p=0.0001), which was accompanied by an improvement in the general condition, increased physical activity, and an earlier start of rehabilitation.

Keywords:COVID-19; pneumonia; anticoagulant therapy; glucocorticosteroid therapy; thiotriazoline; stratification of the risk of an unfavorable prognosis; survival

Conflict of interest. The authors declare that there is no conflict of interest.

Funding. Study conducted without sponsorship.

Сontribution. Idea, concept and design of the study, collection of material, creation of a database, statistical data processing, editing, review of publications on the topic, approval of the manuscript for publication – Salivonchyk D.P.; idea, editing, approval of the manuscript for publication – Stoma I.O.; discussion of the results, editing – Dotsenko E.A.; discussion of the results, editing of the article – Kudenchuk N.N.; discussion of the results, statistical processing, editing of the article – Salivonchyk E.I.; the idea, concept and design of the study, editing – Khudyakov I.A.; concept and design of the study, editing of the article – Menshakova M.N.; collecting material, editing – Malashchenko E.I.; creating a database, statistical processing, editing the list of references – Salivonchyk S.D.; editing, creating a list of references – Bondareva K.O.; editing, creating a list of references – Stepanets E.A., Konovalova O.V.; editing, creating a list of references, approving the manuscript of the article – Kuhoreva E.V.

For citation: Salivonchyk D.P., Stoma I.O., Dotsenko E.A., Kudenchuk N.N., Salivonchyk E.I., Khudyakov I.A., Menshakova M.N., Malashchenko E.I., Salivonchyk S.D., Bondareva K.O., Stepanets E.A., Konovalova O.V., Kuhoreva E.V. COVID-19: the efficacy and safety of anticoagulant, glucocorticosteroid therapy and metabolic. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (1): 47–56. DOI: https://doi.org/10.33029/2305-3496-2022-11-1-47-56

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CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

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