Safety of Pharmacotherapy in COVID-19 Patients: A Literature Review

The safety of COVID-19 pharmacotherapy is a relevant issue, first of all, because of the current lack of experience with using particular medicinal products and with off-label prescribing. The aim of the study was to analyse information on potential adverse drug reactions (ADRs) and their predictors in etiology- and pathogenesis-oriented COVID-19 therapy. According to literature data, the main clinically significant risk factors for COVID-19 patients to develop an ADR are the duration of their hospital stay, combined use of antivirals, polypharmacy, and their history of drug allergies. The most common adverse reactions to antivirals, to virus-neutralising antibodies, and to human anti-COVID-19 immunoglobulin and convalescent plasma are, respectively, gastrointestinal and hepatobiliary disor ders; gastrointestinal disorders, neurological disorders, and allergic reactions; and transfusion reactions (fever, chills, etc.). For pathogenesis-oriented therapy with systemic glucocorticosteroids, the most characteristic ADR is hyperglycaemia. Janus kinase inhibitors and interleukin inhibitors are most often associated with gastrointestinal disorders and hypertransaminasemia; neutropenia is also characteristic of a number of interleukin inhibitors. Haemo static adverse reactions to anticoagulants depend on the patient’s dosing regimen and condition. Drug-drug interactions are a common problem in COVID-19 treatment, with the combination of nirmatrelvir and ritonavir showing the largest number of significant interactions attributed to their pharmacokinetics. Currently, there is data on the role of pharmacogenetic biomarkers in the safety and clinical outcomes of COVID-19 therapy. Thus, to improve the safety of COVID-19 therapy, an integrated approach is needed that will take into account both the clinical, demographic, and pharmacogenetic predictors of ADRs and the risk of drug-drug interactions

Hypotensive therapy of arterial hypertension in chronic limb ischemia and acute thrombotic occlusion

The aim of the investigation was to evaluate the efficacy and safety of the treatment of arterial hypertension syndrome in patients with peripheral arterial disease of the lower and upper extremities and to analyze the efficiency of the effect of operative revascularization of the limb arteries on the course of arterial hypertension.Цель исследования – оценить эффективность и безопасность лечения синдрома артериальной гипертензии у больных с заболеваниями периферических артерий нижних и верхних конечностей и проанализировать эффективность воздействия оперативной реваскуляризации артерий конечностей на характер течения артериальной гипертензии

Character of hematological parameters change in patients with COVID-19

In the first half of 2020, there were reports in the medical press about the presence of signs of polyorganic infection with coronavirus SARS-CoV-2. It was suggested that an additional role in the pathogenesis of COVID-19 hemoglobinopathy, hypoxia and iron overloading of cells of the parenchymatous organs. Based on these concepts and hypotheses, a system of pathogenetic therapy has been formed, but the positions of some hypotheses have not yet been confirmed by clinical studies. To clarify them, additional laboratory tests are required. Objective. To study peripheral blood parameters and their dynamics in COVID-19 patients treated with the diagnosis of «viral pneumonia» in the municipal hospital in Moscow from April to June 2020. Material and methods. Were examined 206 patients (82 men and 124 women) aged 26 to 97 years (average age 56.8±6.1 years) who were undergoing treatment in the 3rd department of GKB No. 15. O.M. Filatov with diagnoses: COVID-19 and pneumonia. 197 of them were discharged from the hospital, 9 died. The study of peripheral blood and counting of leukocyte formula were performed on Cobas Micro and Advia-21-20 analyzers (Simens, Germany). Biochemical studies were performed on spectrophotometer Getpremier (USA). Results. Analysis of the nature of changes in the number of leukocytes in the peripheral blood of patients with COVID-19 and pneumonia showed that cases of leukocytopenia were rare in patients (7% of patients), leukocytosis was detected in more than 20% of patients. The difference between the incidence of leukopenia and leukocytosis was 13.5%, but was not significant (p>0.2). Signs of lymphopenia were observed somewhat more frequently than lymphocytosis (in the evaluation of relative lymphocytosis - by 13.1%), but the difference was not statistically reliable. In assessing the number of lymphocytes in blood in patients with COVID- 19. Conclusion. The data obtained indicate a combined, multi-component pathogenic effect of COVID-19 virus on all three sprouts of hemopoiesis system in pneumonia patients: oppression of erythrocyte saturation processes with hemoglobin, erythropoiesis stimulation in some of them, change in platelet volume, formation of abnormal macroform plates, absence of reactive leukocytosis for acute inflammation, decrease in number of monocytic phagocytes and lymphoid cells. It is possible that some of these changes may affect the prognosis and the severity of the disease course

Strategic solutions for staffing a clinical hospital converted to an infectious hospital during the COVID-19 epidemic

In the context of coronavirus infection pandemic (COVID-19) in City Clinical Hospital 15 named after O.M. Filatov in the short-est possible time, unprecedented reorganization, construction, sanitary and epidemiological changes were carried out to organize the country’s largest infectious diseases clinic. Within a limited time frame, new working conditions were created for medical personnel and other hospital staff, to preserve their health, comfort and safety, to provide round-the-clock emergency care to patients with COVID-19. Such changes and the new working conditions created for medical personnel have allowed an increase in the number of corresponding beds to 1.796 and medical personnel performing diagnostics, treatment and care of patients with COV-ID-19 to 2402, curing over 13.000 patients from April 1 to July 1 Feb 2020

Experience of diagnostics and treatment of COVID-19 patients in the age group 18-30 years in Moscow clinic

During the period of accumulation of scientific data on the pathology of COVID-19 caused by SARS-CoV-2 virus, it was considered that coronavirus is the most dangerous for elderly people, and in young people the disease occurs mainly in mild form. Later on, these perceptions changed. WHO experts, despite their initial recommendations, already recognized the danger of COVID-19 for all ages. Objective. To evaluate the pathology structure in young patients aged 18-30 years who were hospitalized with the diagnosis of COVID-19 in a converted speedy hospital in Moscow in the period from April to June 2020. Material and methods. The data of 228 patients (156 men and 72 women) aged 18-30 years (average age 22.8±3.1 years) admitted to the hospital for diagnostics and treatment in the period from 10.04.20 to 22.06.20 with ICD-10 diagnoses were analyzed retrospectively: B.34.2. Coronavirus infection unspecified; U07.1. COVID-19, the virus is identified (confirmed by laboratory testing, regardless of the severity of clinical signs or symptoms); U07.2. COVID-19, the virus is not identified (COVID-19 is diagnosed clinically or epidemiologically, but laboratory tests are inconclusive or unavailable; J12.9. Extra-hospital pneumonia. Results. In more than 1/3 of patients in the age group 18-30 years COVID-19 with pneumonia developed without a pre-morbid background. The percentage of patients with COVID-19 with chronic upper respiratory tract, lung and pathology with immune regulation disorders was 10-19%, which requires the identification of such patients in the group of high risk of disease. Conclusions. Without severe concomitant diseases, including oncohematological and neurological forms of pathology, COVID- 19 in patients of young age in hospital care and treatment most often does not lead to death

Ticagrelor and thrombolysis in myocardial infarction: what does the TREAT study change?

Primary percutaneous intervention (PCI) is a preferable reperfusion method in patients with STEMI. If on-time PCI is not possible, pharmacoinvasive approach is recommended that includes urgent systemic thrombolysis. Regardless the broad usage of ticagrelor in MI patients, its safety in combination with thrombolysis (first 24 hours from STEMI onset) before the year 2018 was unknown. In the TREAT study the patients 18-75 year old with STEMI (symptom onset within 24 hours), received thrombolytic drug, were randomized to ticagrelor or clopidogrel group. In 30 days from randomization it was shown that hemorrhagic safety of ticagrelor, at the level of major bleedings, was non-inferior than of clopidogrel. Therefore the TREAT study results, together with PLATO, make it to widen the indications for ticagrelor (and shift from clopidogrel) within first 24 hours of MI onset in patients received thrombolysis as a method of primary reperfusion

MODERN APPROACHES TO ANTICOAGULANT THERAPY OF PULMONARY EMBOLISM: FOCUS ON RIVAROXABAN

The analytical article provides a modern state of the anticoagulant therapy in pulmonary thromboembolism. Major advantages and preferential use of direct selective peroral anticoagulants represented by thrombin inhibitor dabigatran and a Xa factor inhibitors composed of apixaban, edoxaban and rivaroxaban. Attention is focused on rivaroxaban the evidence base of which in pulmonary thromboembolism was widened in 2017 by data of the EINSTEIN CHOICE study. Its results allow considering the use of the rivaroxaban 10 mg 1 time per day as a possibility of long-term, actually many year prevention of the pulmonary thromboembolism after the end of the standard course of the therapeutic anticoagulation involving use of a high dosage of the drug (15 mg 2 times per day) for 3 weeks actually from the moment of the disease diagnostics and continuation for 6-12 months of the drug administration at a dose of 20 mg 1 time per day. As a result for many patients with pulmonary thromboembolism use of rivaroxaban at various dosages without transfer to another coagulant allows considerably satisfying the requirements in antithrombotic therapy at various stages of such patients management

Therapeutic potential of apixaban at different stages of management of patients with pulmonary thromboembolism

The article discusses the issues of anticoagulant therapy in pulmonary thromboembolism. It clearly highlights the main advantages and the preferred use of direct selective oral anticoagulants represented by the thrombin inhibitor dabigatran and the factor Xa inhibitor group including apixaban, edoxaban and rivaroxaban. This article provides a thorough introduction of apixaban with an evidence base allowing to consider it a priority anticoagulant, which may be reasonably administered to the majority of patients with pulmonary thromboembolism from the first hours of the disease to many years of secondary prevention

COVID-19 infection after recent heart transplantation: a case report

History of heart transplantation in combination with immunosuppressive therapy and acute viral respiratory infection overlay makes the patient difficult to manage. In case of COVID-19, the setting is complicated by unknown pathogenesis, including its effect on blood, coagulation system, and lung tissue. Current case report discusses the 60-year-old patient with a COVID-19 infection occurred in the immediate postoperative period after heart transplantation

Factors and mechanisms of arterial hypertension development in patients with atherosclerosis of lower limb arteries

The article contains information about the frequency of development of arterial hypertension (AH), the features and causes of its development in patients with peripheral atherosclerosis. AH in patients with chronic atherosclerotic diseases of lower limb arteries and acute thrombotic occlusion complicates the course of this pathology. In most patients, the opinion that AH associated with atherosclerosis due to affection of renal arteries is generally accepted. Currently, an important practical question remains about the possible negative impact of intensive antihypertensive therapy with a significant reduction in blood pressure and aggravation of necrobiosis processes in the ischemic limb in a patient with acute arterial thrombosis