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Blood clots and COVID-19

3d rendered, medically accurate illustration of a blood clot. Blood clots concept.
Image credit: Sebastian Kaulitzki / 123RF

A hospital in the Rajasthan state capital Jaipur has reported an issue taking on greater significance in handling the COVID-19 crisis: blood clots. 

Physicians at the Sawai Man Singh Hospital, which has treated more than 600 patients for COVID-19 according to The Times of India, are witnessing multiple cases of clotting disorders. “We are conducting CT pulmonary angiography and ultrasound of lungs to examine the condition of COVID-19 patients,” said Dr Sudhir Bhandari, principal and controller of SMS Medical College. “We have found that most of the critical patients are presented with clotting disorder with elevated d-dimers.” Bhandari – part of a team of five doctors at the hospital treating COVID-19 patients – explained that “the clots are clogging pulmonary vessels causing death of patients.” 

The American Society of Haematology explains that “blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured. Platelets (a type of blood cell) and proteins in your plasma (the liquid part of blood) work together to stop the bleeding by forming a clot over the injury. Typically, your body will naturally dissolve the blood clot after the injury has healed. Sometimes, however, clots form on the inside of vessels without an obvious injury or do not dissolve naturally. These situations can be dangerous and require accurate diagnosis and appropriate treatment.” 

Blood clots among COVID-19 patients are presenting as issues of significant concern. As described by Dr Mitchell Levy, Chief of Pulmonary Critical care and Sleep Medicine at the Warren Alpert School of Medicine at Brown University in Providence – the capital of the U.S. state of Rhode Island – the presence of blood clots in COVID-19 patients represents “probably the most important thing that’s emerged over the last perhaps month or two.” As a result of COVID-19, Levy said, “we’re seeing clotting in a way in this illness that we have not seen in the past.”

Paul Evans, Professor of Cardiovascular Science at the University of Sheffield in the United Kingdom, observed that “stroke has previously been reported in patients with COVID-19 and this paper provides detailed clinical characteristics of six such patients. Blood tests suggested that all six patients were more prone to form blood clots. 

“The authors therefore suggest that patients with COVID-19 that are at risk of clotting may benefit from anti-coagulation drugs at an early stage, however further studies including clinical trials are required to assess this further. It should be noted that this study does not prove that COVID-19 is a cause of stroke, because patients had several risk factors for stroke that may be independent of viral infection including high blood pressure and abnormal heart rhythm. The study emphasises that more research is required to understand how SARS-CoV-2, the virus that causes COVID-19, alters the behaviour of arteries and the blood components that are involved in clotting.” 

Professor James O’Donnell of Saint James’s Hospital in Ireland states that “COVID-19 is associated with a unique type of blood clotting disorder that is primarily focussed within the lungs and which undoubtedly contributes to the high levels of mortality being seen in patients with COVID-19.” As such, he said, “understanding how these micro-clots are being formed within the lung is critical so that we can develop more effective treatments for our patients, particularly those in high-risk groups.” This, he said, will require “further studies…to investigate whether different blood-thinning treatments may have a role in selected high-risk patients in order to reduce the risk of clot formation.”

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