THE EFFECT OF ANTICOAGULANTS IN THE TREATMENT OF PATIENTS WITH COVID-19
Authors: Dildabekova N. , Romanova A. , Bazarbay S. 
Published: January 2025

At the onset of the COVID-19 pandemic, it became evident that coagulopathy leading to macrovascular and microvascular thrombotic events was a significant potential complication for patients with COVID-19. Increased inflammation and coagulopathy were independently associated with critical illness and all-cause mortality, playing a synergistic role in the pathogenesis of COVID-19. Early observations in China demonstrated the potential benefit of heparin in critically ill patients with COVID-19. However, reports soon emerged of an increased incidence of thromboembolic complications in such patients, both in intensive care units and beyond. This occurred despite the use of standard prophylactic doses of anticoagulants to prevent venous thromboembolism. In response to these findings, many physicians began administering higher doses of anticoagulants, even in the absence of robust scientific evidence of their effectiveness. Autopsy results showing widespread pulmonary microvascular thrombosis suggested that hypoxemia and respiratory failure in COVID-19 were the result of microvascular thrombosis. These findings underscore the understanding that anticoagulant therapy is a critical treatment in managing COVID-19. Methods This study utilized observational data from various hospital settings to evaluate the impact of anticoagulant therapy on patients with COVID-19. Clinical parameters such as D-dimer levels, platelet counts, and coagulation markers were recorded. Patients were categorized based on their anticoagulant therapy:  Standard prophylactic doses  Therapeutic doses The data were analyzed using statistical methods to assess the effectiveness of different dosing strategies. Results 1. Prophylactic anticoagulant use significantly reduced venous thromboembolism (VTE) incidence among hospitalized COVID-19 patients. 2. Patients receiving therapeutic doses of anticoagulants showed improved survival rates, particularly those in critical care settings. 3. Evidence of widespread pulmonary microvascular thrombosis was identified as a primary factor in hypoxemia and respiratory failure among severely ill patients. Discussion The findings highlight the dual role of anticoagulants in mitigating thrombotic complications and reducing inflammation in COVID-19 patients. Heparin’s anti-inflammatory properties, alongside its anticoagulant effects, make it an essential therapeutic tool. The data suggest that early intervention with anticoagulants, even at higher doses, could improve outcomes in severe cases. However, further research is needed to optimize dosing strategies and establish protocols for outpatient and posthospitalization care. Conclusion Anticoagulant therapy, particularly low-molecular-weight heparins (LMWH), has demonstrated significant benefits in managing COVID-19-associated coagulopathy. Early use of anticoagulants can reduce thrombotic events and improve survival rates. Future studies should focus on refining treatment protocols and exploring the broader implications of anticoagulant use in viral illnesses.