akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2022.372akusherstvo-1519Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫDysregulated platelet function in COVID-19 patientsДисрегуляция функции тромбоцитов у больных COVID-19https://orcid.org/0000-0003-0764-4477ГашимоваН. Р.GashimovaN. R.

Гашимова Нилуфар Рамиль кызы – аспирант кафедры акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Nilufar R. Gashimova – MD, Postgraduate Student, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

nelya.94@yandex.ruhttps://orcid.org/0000-0001-8404-1042БицадзеВ. О.BitsadzeV. O.

Бицадзе Виктория Омаровна – д.м.н., профессор РАН, профессор кафедры акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова

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119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Victoria O. Bitsadze – MD, Dr Sci Med, Professor of RAS, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute ofChildren’s Health

Scopus Author ID: 6506003478

Researcher ID: F-8409-2017.

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

https://orcid.org/0000-0002-1339-4155ПанкратьеваЛ. Л.PankratyevaL. L.

Панкратьева Людмила Леонидовна – д.м.н., руководитель научно-клинического центра; врач-неонатолог, врач-гематолог, доцент, профессор кафедры педиатрии и организации здравоохранения

Scopus Author ID: 7006391091

Author ID: 697284.

123423 Москва, ул. Саляма Адиля, д. 2/44;

117997 Москва, ул. Саморы Машела, д. 1

Liudmila L. Pankratyeva – MD, Dr Sci Med, Head of the Clinical Research Center; Neonatologist, Hematologist,Associate Professor, Professor, Department of Pediatrics and Health Organization

Scopus Author ID: 7006391091

Author ID: 697284.

2/44 Salyama Adilya Str., Moscow 123423;

1 Samora Machel Str., Moscow 117997

https://orcid.org/0000-0002-0725-9686ХизроеваД. Х.KhizroevaJ. Kh.

Хизроева Джамиля Хизриевна – д.м.н., профессор кафедры акушерства, гинекологии и перинатальной медицины Клинического института детскогоздоровья имени Н.Ф. Филатова

Scopus Author ID: 57194547147

Researcher ID: F-8384-2017.

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Jamilya Kh. Khizroeva – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 57194547147

Researcher ID: F-8384-2017.

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

https://orcid.org/0000-0001-7441-2778СлуханчукЕ. В.SlukhanchukE. V.

Слуханчук Екатерина Викторовна – к.м.н., доцент кафедры акушерства, гинекологии и перинатальной медицины Клинического института детскогоздоровья имени Н.Ф. Филатова

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Ekaterina V. Slukhanchuk – MD, PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’sHealth

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

https://orcid.org/0000-0002-7756-8935ГригорьеваК. Н.GrigorevaK. N.

Григорьева Кристина Николаевна – ассистент кафедры акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Kristina N. Grigoreva – MD, Assistant, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

https://orcid.org/0000-0001-5888-0774ЦибизоваВ. И.TsibizovaV. I.

Цибизова Валентина Ивановна – к.м.н., врач акушер-гинеколог НИЛ оперативной гинекологии Института перинатологии и педиатрии, врач отделения функциональной ультразвуковой диагностики

197341 Санкт-Петербург, ул. Аккуратова, д. 2

Valentina I. Tsibizova – MD, PhD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics; Physician, Department of Functional and Ultrasound Diagnostics

2 Akkuratova Str., Saint Petersburg 197341

https://orcid.org/0000-0002-9899-9910ГриЖ.-К.GrisJ.-C.

Гри Жан-Кристоф – д.м.н., профессор кафедры акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова; профессор гематологии, зав. лабораторией гематологии факультета биологических и фармацевтических наук; иностранный член РАН

Scopus Author ID: 7005114260

Researcher ID: AAA-2923-2019.

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4;

34090 Монпелье, ул. Огюста Бруссоне, д. 163

Jean-Christophe Gris – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health; Professor of Haematology, Head of the Laboratory of Haematology, Faculty of Biological and Pharmaceutical Sciences

Scopus Author ID: 7005114260

Researcher ID: AAA-2923-2019.

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991;

163 Rue Auguste Broussonnet, Montpellier 34090

https://orcid.org/0000-0002-9576-1368ЭлаламиИ.ElalamyI.

Элалами Исмаил – д.м.н., профессор кафедры акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова; профессор; директор гематологии Центра Тромбозов

Scopus Author ID: 7003652413

Researcher ID: AAC-9695-2019.

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4;

75006 Париж, Улица медицинского факультета, д. 12;

75020 Париж, Китайская улица, д. 4

Ismail Elalamy – MD, Dr Sci Med, Professor, Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health; Professor; Director of Hematology

Scopus Author ID: 7003652413

Researcher ID: AAC-9695-2019.

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991;

12 Rue de l’École de Médecine, Paris 75006;

4 Rue de la Chine, Paris 75020

https://orcid.org/0000-0003-2607-9717АйЦ.AyC.

Aй Джихан – д.м.н., профессор, клиническое подразделение гематологии и гемостазиологии, медицинское отделение I

Scopus Author ID: 55356863800.

1010 Вена, Universitätsring, д. 1

Cihan Ay – MD, PhD, Professor, Department of Medicine I

Scopus Author ID: 55356863800

1 Universitätsring, Vienna 1010

https://orcid.org/0000-0002-3367-9844БлиновД. В.BlinovD. V.

Блинов Дмитрий Владиславович – к.м.н., ассистент кафедры спортивной медицины и медицинской реабилитации Института клинической медицины имени Н.В. Склифосовского; руководитель по медицинским и научным вопросам; доцент кафедры спортивной, физической и реабилитационной медицины

Scopus Author ID: 6701744871

Researcher ID: E-8906-2017. RSCI: 9779-8290.

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4;

127006 Москва, ул. Садовая-Триумфальная, д. 4–10;

123056 Москва, 2-я Брестская ул., д. 5, с. 1–1а

Dmitry V. Blinov – MD, PhD, MBA, Assistant, Department of Sports Medicine and Medical Rehabilitation, Sklifosovsky Institute of Clinical Medicine; Head of Medical and Scientific Affairs; Associate Professor, Department of Sports, Physical and Rehabilitation Medicine

Scopus Author ID: 6701744871

Researcher ID: E-8906-2017

RSCI: 9779-8290.

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991;

4–10 Sadovaya-Triumfalnaya Str., Moscow 127006;

5 bldg. 1–1a, 2-ya Brestskaya Str., Moscow 123056

https://orcid.org/0000-0003-2976-7128СеровВ. Н.SerovV. N.

Серов Владимир Николаевич – д.м.н., профессор, академик РАН, главный научный сотрудник

117997 Москва, ул. Академика Опарина, д. 4

Vladimir N. Serov – MD, Dr Sci Med, Academician of RAS, Professor

4 Academika Oparina Str., Moscow 117997

https://orcid.org/0000-0001-7415-4633МакацарияА. Д.MakatsariyaA. D.

Макацария Александр Давидович – д.м.н., профессор, академик РАН, зав. кафедрой акушерства, гинекологии и перинатальной медицины Клинического института детского здоровья имени Н.Ф. Филатова

Scopus Author ID: 57222220144

Researcher ID: M-5660-2016.

119991 Москва, ул. Большая Пироговская, д. 2, стр. 4

Alexander D. Makatsariya – MD, Dr Sci Med, Academician of RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991

ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский университет)РоссияSechenov UniversityRussian FederationГБУЗ «Городская клиническая больница № 67 имени Л.А. Ворохобова Департамента здравоохранения города Москвы»; ФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия Рогачева» Министерства здравоохранения Российской ФедерацииРоссияVorokhobov City Clinical Hospital № 67, Moscow Healthcare Department; Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Health Ministry of Russian FederationRussian FederationФГБУ «Национальный медицинский исследовательский центр имени В.А. Алмазова» Министерства здравоохраненияРоссияAlmazov National Medical Research Centre, Health Ministry of Russian FederationRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский университет); Университет МонпельеРоссияSechenov University; University of MontpellierRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский университет); Медицинский Университет Сорбонны; Госпиталь ТенонРоссияSechenov University; Medicine Sorbonne University; Hospital TenonRussian FederationВенский университетАвстрияUniversity of ViennaAustriaФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский университет); Институт Превентивной и Социальной Медицины; АНО ДПО «Московский медико-социальный институт имени Ф.П. Гааза»РоссияSechenov University; Institute for Preventive and Social Medicine; Haass Moscow Medical and Social InstituteRussian FederationФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Министерства здравоохранения Российской ФедерацииРоссияAcademician Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Health Ministry of Russian FederationRussian Federation202214012023166692705Copyright © Gashimova N.R., Bitsadze V.O., Pankratyeva L.L., Khizroeva J.K., Slukhanchuk E.V., Grigoreva K.N., Tsibizova V.I., Gris J., Elalamy I., Ay C., Blinov D.V., Serov V.N., Makatsariya A.D., 20232023Гашимова Н.Р., Бицадзе В.О., Панкратьева Л.Л., Хизроева Д.Х., Слуханчук Е.В., Григорьева К.Н., Цибизова В.И., Гри Ж., Элалами И., Ай Ц., Блинов Д.В., Серов В.Н., Макацария А.Д.Gashimova N.R., Bitsadze V.O., Pankratyeva L.L., Khizroeva J.K., Slukhanchuk E.V., Grigoreva K.N., Tsibizova V.I., Gris J., Elalamy I., Ay C., Blinov D.V., Serov V.N., Makatsariya A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1519

More than two year-experience in monitoring patients with severe novel coronavirus disease revealed an increased risk of macroand microcirculatory thrombosis, clinically manifested by heart attack, stroke, thromboses of rare localizations (thrombosis of the hepatic veins, mesenteric veins, cerebral sinuses, portal vein), being the main cause of adverse outcomes. Thromboembolic complications, expressed as sepsis-induced coagulopathy, disseminated intravascular coagulation, venous and arterial thromboembolism, pulmonary embolism, microthrombosis, and thrombotic microangiopathy were noted to affect various organs such as the lungs, heart, kidneys, and brain. Earlier, we showed that hypercoagulability is closely related to inflammatory diseases and hemostasis dysregulation. Endothelial injury and dysfunction have been identified as critical pathways to thrombosis, and other mechanisms occurring in the microvasculature were described such as endothelial activation, cytokine storm, and formation of neutrophil extracellular traps (NETs). However, a role of platelets in severe COVID-19 has not been examined. Platelets are small non-nucleated cells most known as the central mediators of hemostasis. However, upon activation, platelets release a variety of immunomodulatory cytokines and chemokines involved in regulating immune response. Because platelets are involved in both immunity and coagulation, they play a central role in immunothrombosis, a physiological process wherein immune cells induce microthrombogenesis both to prevent spread of pathogens and facilitate their clearance. Moreover, platelets can directly interact with viral receptors including those related to SARS-CoV-2. Platelet dysfunction includes both thrombocytopenia and platelet hyperactivation. It should be noted that persistent thrombocytopenia is usually correlated with mortality being associated with thrombosis of the cerebral sinuses, splanchnic system, autoimmune reactions, as well as with administered heparin and vaccines. Therefore, here we review a role of platelets in the pathogenesis of COVID-19.

Более чем двухлетний опыт наблюдений за пациентами с тяжелой коронавирусной болезнью показал повышенный риск тромбозов макро- и микроциркуляторного русла, клинически проявляющихся инфарктом, инсультом, тромбозами редких локализаций (тромбоз печеночных вен, мезентериальных вен, синусов головного мозга, воротной вены), что является основной причиной неблагоприятных исходов. Было отмечено, что тромбоэмболические осложнения, выраженные в виде сепсис-индуцированной коагулопатии, диссеминированного внутрисосудистого свертывания крови, венозной и артериальной тромбоэмболии, эмболии легочной артерии, микротромбоза и тромботической микроангиопатии, поражают различные органы, такие как легкие, сердце, почки и головной мозг. Ранее мы писали о том, что гиперкоагуляция тесно связана с воспалительными заболеваниями и дизрегуляцией гемостаза. Повреждение и дисфункция эндотелия были определены как критические пути к тромбообразованию, а также были описаны и другие механизмы, происходящие в микрососудистой сети, такие как активация эндотелия, цитокиновый шторм и образование внеклеточных ловушек нейтрофилов (англ. neutrophil extracellular traps, NETs). Однако роль тромбоцитов в тяжелых случаях COVID-19 не была изучена. Тромбоциты – небольшие безъядерные клетки, которые наиболее известны как центральные медиаторы гемостаза. Однако при активации тромбоциты выделяют множество иммуномодулирующих цитокинов и хемокинов, которые участвуют в регуляции иммунного ответа. Поскольку тромбоциты участвуют как в иммунитете, так и в коагуляции, они играют центральную роль в иммунотромбозе, физиологическом процессе, при котором иммунные клетки индуцируют образование микротромбов как для предотвращения распространения патогенов, так и для облегчения их выведения. Более того, тромбоциты могут непосредственно взаимодействовать с вирусными рецепторами, в том числе с коронавирусной инфекцией. Дисфункция тромбоцитов включает в себя как тромбоцитопению, так и гиперактивацию тромбоцитов. Следует отметить, что упорная тромбоцитопения, как правило, коррелирует со смертностью и связана с тромбозом церебральных синусов, спланхнической системы, аутоиммунными реакциями, а также с применением гепарина и вакцин, поэтому в данном обзоре рассматривается роль тромбоцитов в патогенезе COVID-19.

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The authors declare that there are no conflicts of interest present.