Inflammatory markers MCP1 and IP 10 in patients with COVID-19 undergoing anticoagulant therapy

BACKGROUND: COVID-19 is associated with inflammation and extensive changes in hemostasis. This study aimed at evaluating changes in levels of inflammatory markers MCP1 and IP 10 in patients with COVID-19 undergoing anticoagulant therapy.METHODS: A prospective cohort study included 370 patients with COVID-19 who received different types of anticoagulants: group 1 - low molecular weight heparins (LMWH), group 2 - unfractionated heparin (UFH), group 3 - direct oral anticoagulants (DOACs). All subjects underwent physical examination, basic laboratory testing and evaluation of serum MCP1 and IP 10 levels. All subjects underwent Duplex ultrasonography of the lower extremity veins to assess the incidence of deep venous thrombosis. Pulmonary embolism (PE) was assessed when suspected.RESULTS: A statistically significant reduction of levels of inflammatory (MCP1, IP 10) and hemostatic markers was observed in COVID-19 patients who received LMWH. COVID-19 subjects who received UFH (group 2) had a statistically significant reduction in c-reactive protein (CRP) level while ferritin levels remained elevated; IP 10 level decreased while MCP-1 level remained stable; additionally, we observed a decrease in such parameters as prothrombin time and fibrinogen, while there was no statistically significant reduction in D-dimer level. In group 3 patients who received DOACs there was a decrease in levels of IP 10, erythrocyte sedimentation rate, CRP, while ferritin level increased. Analysis of venous thromboembolism (VTE) incidence has shown that patients who received UFH had the highest VTE rates (11.4% had PE without lower extremity DVT, 6.5% had DVT, 6.5% had PE in presence of lower extremity DVT).CONCLUSIONS: There was an association between the VTE incidence, types of anticoagulant therapy and inflammatory markers (MCP1 and IP 10). Initial MCP1 level higher than 90 pg/l was associated with a 10.742 (1.135-101.647) higher chances of developing PE (P=0.038). Initial IP 10 level higher than 700 pg/mL was associated with a 7.936 (2.066-30.3) higher chances of developing PE (P=0.003).