Treating blood clots, kidney injuries and other problems linked to COVID-19 could save lives – WHYY

Abnormal blood clots

Jabbour and other doctors say COVID-19 is causing a lot of abnormal blood clots around the brain, heart and blood vessels in general. This is such a big problem that medical staff at Jefferson are thinking about preemptively starting COVID-19 patients on blood thinners, according to Jabbour.

Among a group of COVID-19 patients in intensive care at the University of Colorado Anschutz Medical Campus, some are literally clotting off every blood vessel in their body, said transplant surgery fellow Hunter Moore. He added these patients blood clots are not breaking down, so 30% of them have strokes, and half of them have blood clots blocking blood flow to the lungs.

A Dutch study of 184 COVID-19 patients in intensive care in three hospitals found that a remarkably high 31% had blood clotting complications. This builds on similar early findings from Wuhan, China.

What does a virus that causes breathing problems have to do with blood clots?

Scientists have yet to understand this fully, but here are the main ideas, according to Adam Cuker, a hematologist and associate professor of medicine at the University of Pennsylvania:

When someone becomes infected with the new coronavirus, or really anything that could be harmful, the body starts an inflammatory response. Scientists know there is a connection between inflammation and blood clotting, such as the release of more blood-clotting proteins, hence the higher risk of abnormal blood clots in COVID-19 patients.

The new coronavirus can also infect the cells that line the blood vessels. The body treats that as an injury, so the blood starts clotting.

That makes good sense from an evolutionary perspective because if we were to cut ourselves, we want a clot to form at the site of injury, Cuker said. But in this situation, that adaptive response goes too far, and ends up putting the patient at great risk for pathological clotting.

He added that doctors at Penn Medicine are sufficiently worried about blood clotting issues continuing after COVID-19 patients are discharged, so they are sending some patients out with medication for it.

Regina Marston returned to her California home from a trade show in Las Vegas in January with a bad cough, a fever and chills. She later developed a dull pain in her lungs on the right side, and a scan revealed a blood clot.

I had so much pain I still cant lay on my right side, she said. Im not comfortable laying flat, I still wake up a lot throughout the night.

Her doctor put her on blood thinners for five weeks, and she is now being tested for COVID-19.

COVID-19 can also mimic a heart attack, either through inducing inflammation of the heart muscle, or possibly causing tiny blood clots. Its not entirely clear how, said Jay Giri, a cardiologist at the University of Pennsylvania. This has come up enough that doctors at Penn Medicine have changed their procedures in emergency rooms slightly.

Usually, when an emergency room doctor sees a certain pattern on an electrocardiogram, doctors diagnose a heart attack, and the patient gets rushed to a cardiology procedure suite right away. Its not uncommon for heart attack patients to have trouble breathing, sometimes even requiring a breathing tube, so doctors cant always ask a patient what is going on with their symptoms.

Were just so used to rushing the patient into the procedures suite in minutes, no question, find a blocked up blood vessel that were rushing to open to stop (the) heart attack, Giri said.

But during the pandemic, doctors sometimes find there is no blockage. A lab test leads to a COVID-19 diagnosis.

Before, its like you drop the phone and youre running to your car. Now at least youre having a one minute conversation: Does the patient have a fever? And then that would raise your suspicion of COVID.

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Treating blood clots, kidney injuries and other problems linked to COVID-19 could save lives - WHYY