To reveal if coagulopathies relate to the course of COVID-19, we examined 255 patients with moderate and severe COVID-19, receiving anticoagulants and immunosuppressive drugs. Coagulopathy manifested predominantly as hypercoagulability that correlated directly with systemic inflammation, disease severity, comorbidities, and mortality risk. The prolonged clotting tests in about ¼ of cases were associated with high levels of C-reactive protein and antiphospholipid antibodies, which impeded coagulation in vitro. Contraction of blood clots was hindered in about ½ of patients, especially in severe and fatal cases, and correlated directly with prothrombotic parameters. A decrease in platelet contractility was due to moderate thrombocytopenia in combination with platelet dysfunction. Clots with impaired contraction were porous, had a low content of compressed polyhedral erythrocytes (polyhedrocytes) and an even distribution of fibrin, suggesting that the uncompacted intravital clots are more obstructive but patients could also be prone to bleeding. The absence of consumption coagulopathy suggests the predominance of local and/or regional microthrombosis rather than disseminated intravascular coagulation. The results obtained (i) confirm the importance of hemostatic disorders in COVID-19 and their relation to systemic inflammation; (ii) justify monitoring of hemostasis, including the kinetics of blood clot contraction; (iii) substantiate the active prophylaxis of thrombotic complications in COVID-19.

Background Congenital and acquired hemostatic disorders are among the pathogenic factors of pregnancy loss. Studying mechanistic relations between impaired hemostasis and fetal losses is important for the prognosis and prophylaxis of obstetric complications. Objective This article aims to establish latent hemostatic disorders in nonpregnant women as an important premorbid risk factor of pregnancy loss. Methods and Results Hemostasis was characterized using two relatively new in vitro assays, namely thrombodynamics (spatial clot growth) and kinetics of blood clot contraction, which together reflect the hemostatic or thrombotic potential. In addition, platelet functionality was assessed using flow cytometry. Our study included 50 women with a history of pregnancy loss and 30 parous women without previous obstetric complications. In patients with pregnancy loss, hypercoagulability was observed along with significant impairment of blood clot contraction associated with chronic platelet activation and dysfunction. Both hypercoagulability and defective clot contraction were significantly more pronounced in patients with a history of three or more miscarriages compared with patients with a history of one or two miscarriages. In addition, a significant inhibition of clot contraction was found in patients with miscarriage occurring after 10 weeks of gestation compared with those who lost a fetus earlier in pregnancy. Conclusion These results indicate that chronic hypercoagulability and impaired clot contraction constitute a premorbid status in patients with pregnancy loss. The data confirm a significant pathogenic role of hemostatic disorders in pregnancy loss and suggest the predictive value of thrombodynamics and blood clot contraction assays in evaluating the risk of pregnancy loss.

Венозные тромбоэмболические осложнения (ВТЭО) остаются важной причиной заболеваемости и смертности во время беременности, несмотря на достаточный арсенал антикоагулянтов и знания в области профилактики и лечения тромбозов у небеременных пациенток. Беременность, даже физиологически протекающая, сопровождается 4-5-кратным повышением риска возникновения ВТЭО. Известно также, что во время беременности меняется фармакокинетика лекарственных препаратов, и при назначении того или иного препарата беременной всегда есть сомнения в его достаточной безопасности и эффективности.Врожденная или приобретенная тромбофилия, несомненно, увеличивает риск развития ВТЭО во время беременности, но не является ведущей причиной. Как правило, в случае тромбоза во время беременности у пациентки выявляются дополнительные факторы риска: ожирение, *

The new coronavirus infection caused by the SARS-CoV-2 virus (COVID-19) is characterized by a high frequency of thrombotic complications varying from venous or, more rarely, arterial thrombosis to the development of disseminated intravascular coagulation (DIC) and/or diffuse pulmonary vascular microthrombosis, which aggravates the disease and becomes one of the leading causes of deaths. Timely and personalized anticoagulant thromboprophylaxis with low-molecular-weight heparins may prevent a severe course of the disease and improve outcomes. This applies to outpatients, hospitalized patients and patients in the early post hospital period. In the future, to develop comprehensive and evidence-based guidelines on the management of patients with COVID-19, it is necessary to conduct comprehensive systematic studies and comparative clinical trials of prophylaxis and treatment of hemostatic disorders in patients with COVID-19.

Deep cerebral venous thrombosis is a rare pathology and hard to diagnose cause of the acute cerebrovascular diseases. Commonly, the veins of Galen and Rosenthal affected by the non-isolated deep cerebral venous thrombosis are described in most of the publications. The article presents a clinical case of an extremely rare isolated deep cerebral venous thrombosis in a female patient aged 31 years with a burdened obstetric history and thrombophilia. The disease onset started with increasing hypertension headache, congestive changes in the fundus, cerebellar and pyramidal signs. Magnetic resonance imaging (MRI) of the brain revealed a pattern of a multi-focal brain lesion. Thus, the primary diagnosis of «multiple sclerosis» was established, so the patient received pulse therapy. Differential diagnosis was conducted with systemic connective tissue diseases. Regression of headaches, of changes in the fundus, dynamic neuroimaging data, and the results of hematology test made it possible to diagnose «deep cerebral venous thrombosis». During the anticoagulant therapy, there was a positive dynamics: the foci significantly regressed according to MRI data, the patient became pregnant and delivered a healthy child. The article describes the characteristics of MRI images on deep cerebral venous thrombosis, which can be used to diagnose this patholo gy. KEYWORDS: deep cerebral venous thrombosis, сerebral venous sinus thrombosis, thrombophilia, coagulopathy, infertility, headache, multiple sclerosis. FOR CITATION: Matveeva T.V., Ibatullin M.M., Gaifutdinov R.T. et al. Isolated deep cerebral venous thrombosis. Russian Medical Inquiry. 2020;4(9):595–600. DOI: 10.32364/2587-6821-2020-4-9-595-600.