Surgical hemorrhagic complications in COVID-19 patients: risk factors and development mechanisms

Abstract

A trigger mechanism plays a leading role in the pathogenesis of hemorrhagic syndrome in COVID-19. On one hand; the development of heparin-induced coagulopathy is not excluded; on the other hand; the development of critical conditions is accompanied by the release of proinflammatory factors into the bloodstream. SARS-CoV-2 – associated endotheliopathy is considered as an additional link in the pathological process.The aim of the study is to determine main risk factors and mechanisms of development of surgical hemorrhagic complications in COVID-19 patients on the basis of a comprehensive clinical; laboratory and instrumental examination; including pathomorphological and immunohistochemical studies.The study included 115 patients with recurrent gastrointestinal bleeding and 24 patients with spontaneous hemorrhages in soft tissues. It was found that with high reliability (p<0.05); the development of surgical hemorrhagic complications of COVID-19 correlated with an increase in INR; a decrease in PTI; the presence of COPD; as well as the development of gas syndrome and sepsis. An immunohistochemical study using monoclonal antibodies to CD31 and CD34 receptors expressed on the surface of the endothelium revealed an alteration of the endothelial monolayer; contributing to the occurrence of a hemorrhagic event.Thus; it can be assumed that an increase in the frequency of gastrointestinal bleeding and spontaneous hemorrhages in soft tissues of various anatomical locations in COVID-19 patients may be associated with the direct cytopathic effect of the SARS-CoV-2 virus on endotheliocytes (destruction of the vascular wall due to degradation of the endothelial layer); which determines the formation of a single pathogenetic mechanism of development hemorrhages in COVID-19.