Abstract
<jats:p>Given that thrombotic inflammation is the core pathogenesis of coronavirus disease (COVID-19), current clinical guidelines recommend anticoagulant therapy for all hospitalized COVID-19 patients. However, indications for continuing anticoagulant therapy after discharge remain uncertain. The aim of the study was to determine the rationale for anticoagulant therapy in patients who survived severe or critical COVID-19, after hospitalization. Materials and Methods. The study included 49 individuals (age: 59.0 (47.0; 66.0) years; 26 (53.1 %) males and 23 (46.9 %) females) who had recovered from severe or critical community-acquired pneumonia associated with COVID-19. The evaluation was conducted on day 45.0 (35.0; 65.0) from the onset of the first COVID-19 symptoms. The examination included medical history and symptom assessment, review of medical records, physical examination, pulse oximetry (SpO2), and laboratory tests (C-reactive protein (CRP), D-dimer, platelet count). Patients were followed up to day 180.0 (162.5; 190.0) from the onset of symptoms. The statistical method used was the Kaplan-Meier survival analysis with the construction of survival curves. Results. Subgroup 1 consisted of 8 (16.3 %) patients (anticoagulant intake limited to the hospitalization period), and subgroup 2 – of 41 (83.7 %) patients (anticoagulant therapy continued after hospital discharge). The clinical course during the acute and early post-acute periods in subgroup 1 was more favorable compared to subgroup 2, as assessed by SpO2 levels in the acute and post-acute periods, CRP levels in the acute period, and the severity of dyspnea in the post-acute period (p < 0.05). Venous thromboembolism in the early post-acute period was diagnosed in 5 (62.5 %) patients from subgroup 1 and in only 2 (5.0 %) patients from subgroup 2. A significant increase in the risk of VTE development was established for subgroup 1 compared to subgroup 2 (HR = 17.4 (95% CI 1.9–62.0), log-rank test p < 0.001). Conclusions. Patients after severe or critical COVID-19 should receive anticoagulants not only in the acute phase but also during the post-acute period of the disease, regardless of clinical and laboratory parameters characterizing the course of the acute and post-acute COVID-19 periods (severity of respiratory failure and laboratory markers).</jats:p>