Consequences of coronavirus infection: Hemorheological disorders and possibilities for correction

Aim. To study intravascular changes in hemostasis and changes in electrical, viscoelastic parameters of erythrocytes in COVID-19 convalescents and to evaluate the effectiveness of the pharmacological composition of nicotinamide, cocarboxylase, trifosadenine, cyanocobalamin for intramuscular administration (Cocarnit® drug) and cytidine diphosphocholine (citicoline, Ronocit® drug) to eliminate hemorheological disorders.

Materials and methods. Examined 308 patients (154 men and 154 women), average age 53.1±13.8 years, COVID-19 convalescents, within 2 to 14 months after the disease, 50 people of comparable age and gender who had not suffered COVID-19. 42 patients from the main group who had suffered coronavirus infection received complex therapy (taking the drugs Ronocit® and Cocarnit® (World Medicine Ilac San. Ve Tic. A.S., Turkey), and were re-examined after 8 weeks. The electrical, viscoelastic parameters of erythrocytes were studied by dielectrophoresis using an electro-optical cell detection system; hemostasis parameters were studied by standard methods.

Results. COVID-19 convalescents revealed a marked decrease in the surface charge of erythrocytes with an increased tendency to aggregate formation, a decrease in the ability to deform against the background of high summarized viscosity and rigidity, the predominance of immature cells with reduced polarizability, high readiness for hemolysis, with a significantly altered structure of erythrocyte membranes associated with their thickening and increased ability to conduct electric current (p=0.05–0.00001). Changes in the cellular link, endothelium and leukocytes proved to be dominant in the activation of hemostasis and indicated the course of endotheliitis (p=0.00001). Combined therapy with Ronocit® and Cocarnit® drugs for 8 weeks led to an increase in the diameter of erythrocytes, the proportion of discocytes, a decrease in the proportion of deformed cells and spherocytes (p=0.00007–0.003), an increase in the amplitude of deformation of erythrocytes at high electric field frequencies (10⁶, 5×10⁵ Hz), membrane capacity and a decrease of summarized rigidity and viscosity (p=0.0003–0.04), a decrease in the electrical conductivity of cell membranes, an increase in the speed of movement of red blood cells to the electrodes, the magnitude of the dipole moment; there was a mixing of the crossover frequency into the low frequency range (p=0.0001–0.052). A decrease in the degree of hemolysis was revealed, to a greater extent at low frequencies of the electric field (p=0.0004–0.05), an increase in polarizability at frequencies 5×10⁵, 10⁵, and 5×10⁴ Hz (p=0.005–0.05) and relative polarizability (p=0.001). The normalization of the Willebrand factor level (p=0.0001) was noted, reflecting the restoration of the integrity and function of the endothelium. Intravascular coagulation indices, estimated by the level of soluble fibrin-monomer complexes, decreased (p=0.018). Normalization of bleeding duration (p=0.012), prolongation of clotting time (p=0.001) against the background of complex therapy were established.

Conclusion. The use of complex therapy with Cocarnit® and Ronocit® drugs made it possible to improve the electrical, viscoelastic parameters of erythrocytes, normalize intravascular disorders and eliminate endotheliitis in COVID-19 convalescents, creating the basis for further development of pathogenetic therapy for postcovid syndrome.