Numerous doctors have discovered another baffling effect of the coronavirus on patients. Dr. Jeffrey Laurence, a hematologist at Weill Cornell Medicine in New York City, stated that the number of clotting problems that they are seeing in the ICU that are all related to COVID-19 is unprecedented. Blood clotting problems are widespread in severe COVID-19 cases.
Dr. Laurence and his colleagues studied the autopsies on two COVID-19 patients and they found blood clots in the lungs and beneath the surface of the skin. They also found blood clots beneath the skin's surface on three living patients.
A study found high rates of clotting among COVID-19 patients in the ICU in the Netherlands. Experts from more than 30 hospitals had gathered to consider the ongoing issue and they conclude that coronavirus patients may be predisposed to having clots but it is not clear why.
Increasing rates of blood clots
Dr. Michelle Gong, chief of the division of critical care medicine at Montefiore Medical Center in New York City stated that being in the ICU, sick and lying still, can be the reason for blood clots. She said that even before COVID-19, doctors are on high alert for suspicion of clots in the ICU because they are at high risk. But even with this explanation, doctors believe that COVID-19 patients are clotting more than other ICU patients.
A study of 81 ill patients in Wuhan China in the ICU with COVID-19 found a 25% incidence of clots. A Dutch study of 184 patients in the ICU with COVID-19 found more than 20% were having blood clotting issues.
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Dr. Behnood Bikdeli, a cardiovascular medicine fellow at Columbia University Irving Medical Center, called the numbers alarming. He also said that there are three major reasons why COVID-19 patients might have a high risk of clotting.
The first reason is that the vast majority of patients who become very will with coronavirus have underlying medical problems such as heart disease, diabetes, and high blood pressure. The second reason is because of a cytokine storm, it is where the body's own immune response turns on itself. And the third reason is that there could be something about the coronavirus itself that is causing blood clots.
Doctors say that it is difficult to know exactly what is behind the blood clots that they are seeing in COVID-19 patients who are in the ICU.
A difficult fix
It is not that easy to fix the clotting issues. While a low dose of blood thinners to prevent blood clots is considered low risk, that might not be enough to prevent clots in some patients. However, giving larger doses could make a patient bleed excessively and that could be deadly.
That is the dilemma that doctors are facing now. Some patients might benefit from larger doses of blood thinners because they are ill with COVID-19 and their blood tests show that they have elevated levels of D-dimer, which is a substance that indicated that they might have clotting issues.
According to Dr. Kathryn Hibbert, an instructor at Harvard Medical School, there is a crying need for these kinds of rapid trials. Dr. Laurence stated that since treating clotting can be tricky, he wants to figure out what is causing the clotting in the first place. Doctors are trying to shut off what is causing it, there is clotting going on with COVID-19 patients and they are trying to keep ahead of it.
While there is still no answer regarding these issues and while studies are being done, doctors are being extra vigilant with treating their COVID-19 patients.
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