Posted on: April 23, 2020 at 2:41 pm
When the COVID-19 pandemic first began, it appeared that the virus was strictly a respiratory condition. Of course, this new virus was much more contagious and lethal, and with no treatment, vaccine, or cure, a much more serious problem.
As the weeks have worn on, and the number of infections has continued to increase, however, doctors are beginning to see a very troubling trend. Not only have they begun to observe how the virus attacks parts of the body other than the lungs like the liver, kidneys, heart, intestines, and brain, but they are seeing more and more patients with numerous, severe blood clots.
Blood-Clotting Killing Patients
Craig Coopersmith, a critical care surgeon, says that some doctors in health care centers around the country have reported unusual blood clotting in as many as forty percent of their COVID-19 patients. The concern has now become so great that doctors are preemptively giving blood thinners to all of their coronavirus patients [1].
It is not unusual for one or two ICU patients to develop blood clots even while on blood thinners, but when several patients begin to have clotting problems, it signifies a more serious issue. Once dialysis machines, which filter impurities from the blood, started getting clogged multiple times per day, doctors knew something was wrong.
Autopsies on deceased COVID-19 patients, in which doctors expected to find damage to the alveoli in the lungs, instead revealed tiny blood clots all over the lungs.
Currently, doctors and medical researchers don’t know why or how this is happening, but they do believe that blood clotting is responsible for many of the deaths from the virus in the United States, and why so many people with seemingly mild cases are dying at home.
“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” said Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine. “We don’t know. And therefore, we are scared.” [1]
Read: For survivors of severe COVID-19, beating the virus is just the beginning
The Connection Between Heart Disease and Severe COVID-19
Dr. Behnood Bikdeli, a cardiovascular medicine fellow at Columbia University Irving Medical Center, believes that there are three main reasons why COVID-19 patients might have a higher risk of blood clotting.
He says a large percentage of patients with a severe case of the virus have underlying medical conditions such as diabetes, heart disease, and high blood pressure, which would put them at a higher risk for blood clotting, even if they didn’t have the virus.
Secondly, another way the virus can kill someone is by making their own immune system turn on them. When this happens, you are also at an increased risk for blood clotting.
Thirdly, it could be that there is something about the behavior of the virus itself that is causing clotting. Doctors, unfortunately, do not yet know why or how that could be happening.
“My gut tells me there are probably a subset of Covid patients who have really abnormal clotting behavior, that this is happening more frequently than we would expect it to,” says Dr. Kathryn Hibbert, instructor at Harvard Medical School [2].
Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, explained that doctors still are not sure whether the virus is attacking blood vessels directly, or if the clots are the result of an overactive inflammatory response.
“One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In covid-19, it’s more blood clots,” he said [1].
While this problem has been recorded in other hard-hit countries like Italy and China, it has been much more obvious to American doctors. Helen W. Boucher, an infectious-disease specialist at Tufts Medical Center, says that this is not because the virus in America is different from other parts of the world, but is more likely to do with the demographics of the population. A larger percentage of patients in the US have health problems such as heart disease and obesity, which makes them more likely to develop a blood clotting problem [1].
Read: Former CDC Chief: Vitamin D May Reduce The Risk Of Coronavirus Infection
A New Worry for Doctors
49-year old Michael Reagan had been diagnosed with COVID-19 in late March and had been recovering at his home in New York for several weeks. Just when he started to feel better, however, he suddenly spiked a high fever and began having chest pains. When he went to the hospital, he found out that he had blood clots in his lungs.
“It feels like a toxin is in my body,” he said [3].
Another patient, 41-year-old Broadway actor Nick Cordero, had to have his right leg amputated after the virus caused blood clots that prevented blood from getting to his toes [1].
This has become an area of great concern for doctors. Autopsy data from Northwell Health reported that about forty percent of patients who died after leaving the hospital experienced “major clotting events”, such as a massive heart attack or lung clots [3].
“My guess is it’s one of the top three causes of demise and deterioration in covid-19 patients,” said Bikdeli [1].
Read: ‘You are safer outside than inside’: Disease expert criticizes restrictions
A Difficult Problem to Solve
Usually, a low dose of blood thinners given to patients is considered low-risk, however, coronavirus patients may need a higher amount in order to be effective. Higher dosages, however, have the potential to make patients bleed excessively, which could also be deadly [2].
There has now been a call for research into blood clotting in coronavirus patients, to figure out what specifically is causing it.
“We’re trying to shut off what’s causing it,” said Dr. Jeffrey Laurence, a hematologist at Weill Cornell Medicine in New York City. “There’s over exuberant clotting going on with Covid patients, and we’re trying to keep ahead of it.” [2]
Until doctors know more, they are practicing extreme vigilance with their COVID-19 patients. Hibbert says that whatever information they learn could change the way doctors practice medicine in the future.
“This is one of the many challenges in taking care of critically ill patients and trying to decide if what you’re seeing at the bedside is rare and happening by chance, or if it’s part of a larger pattern that could change your practice.”
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