Malignant Neoplasms in COVID-19

Pathogenetic risks and thrombosis

Management of patients with coronavirus infection requires careful analysis of predictors of vascular catastrophes. Active malignant neoplasm belongs to the category of major risk factors for intravascular coagulation, provoking the development of deep vein thrombosis (DVT) and pulmonary embolism (PE).

In addition to oncopathology, main triggers include:

• Severely restricted physical mobility (forced bed rest).
• History of DVT or PE in the patient.
• Recent major surgery or severe trauma within the preceding month.
• Congenital and acquired thrombophilias: deficiency of natural anticoagulants (antithrombin, proteins C and S), presence of antiphospholipid syndrome, Factor V Leiden mutation, as well as the G-20210A prothrombin gene mutation.

Additional aggravating factors

The presence of a malignant tumor is often accompanied by a comorbid background. Additional risk factors become clinically significant precisely when combined with the underlying disease. Such conditions include pronounced heart or respiratory failure, systemic connective tissue diseases, and alimentary obesity.

The patient's endocrine status plays an important role. The use of systemic hormonal contraceptives or hormone replacement therapy acts as significant additional triggers that, in combination with the oncological process, require immediate correction of the antithrombotic strategy.

Specific antithrombotic prophylaxis

To minimize vascular risks, the administration of oral antithrombotic agents is indicated. Their use is strictly regulated: they are used when there is a confirmed presence of thrombosis risk factors, an objectively low risk of potential bleeding, and exclusively if the patient is not receiving these drugs for other medical indications.

Among specific medications, (N-(5-chloropyridin-2-yl)-5-methyl-2-(4-(N-methylacetimidamido)benzamido)benzamide hydrochloride) stands out. This drug is prescribed at a dosage of 60 mg once daily, and the duration of the course can reach 30 days. Its clinical efficacy in the prevention of DVT and PE has been reliably studied both in patients with COVID-19 and in major orthopedic interventions.

It is important to differentiate prescriptions: for example, the efficacy of dabigatran etexilate in the context of DVT/PE prevention has been proven only in major orthopedic surgeries, which limits its routine use in infectious patients without a corresponding surgical history.

Biochemical markers and oxidative stress

The pathogenesis of the combined course of infection and oncology is accompanied by pronounced metabolic disorders. Modern research work focuses on studying biochemical markers of various pathological conditions.

Comprehensive analysis of oxidative stress parameters is of fundamental importance. The identification of specific biochemical markers allows not only for the early diagnosis of clinical deterioration in COVID-19, gynecological pathologies, or urolithiasis, but also for the accurate assessment of dynamics during therapy with drugs that have pronounced antioxidant properties.

Academic school and research development

The study of complex pathological mechanisms relies on the fundamental works of domestic scientists. New approaches to the diagnostics and therapy of malignant neoplasms were actively developed at the Department of Biology under the leadership of T.G. Shcherbatyuk from 2002 to 2019.

Historically, the scientific base was formed over decades:

• 1930–1961 — V.D. Semyonov established the Nizhny Novgorod school of helminthology.
• 1961–1992 — B.P. Solopaev laid the foundations of the doctrine on the regeneration of pathologically altered organs. Thanks to his contribution, in 1980–1985 the institute became the country's leading center for the "Liver Regeneration" program.
• 1992–2002 — V.V. Sadovnikova studied the effect of a pulsed magnetic field on regenerative processes.

Today, the integration of students into this scientific environment is carried out through specialized Olympiads (in genetics and parasitology), student research club activities, and participation in the All-Russian Conference with international participation "Solopaev Readings".

Forms of knowledge assessment

For a deep understanding of the material, a multi-stage control system is provided:

1. Current assessment at lectures and practical classes with keeping a workbook.
2. Writing tests on fundamental sections.
3. Computer testing in the first semester.
4. Evaluation of independent work study notes over two semesters.
5. Final exam and examination testing at the end of the second semester.

Class and exam questions

What else to study on this topic

• Pathogenesis of hereditary thrombophilias: the impact of the prothrombin G-20210A gene mutation on hemostasis
• The role of systemic connective tissue diseases as an additional risk factor for thrombosis
• Dynamics of oxidative stress biomarker levels during antioxidant use
• Mechanisms of regeneration of pathologically altered organs (the legacy of B.P. Solopaev)
• The effect of hormone replacement therapy on the blood coagulation system

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.