In the fight against the novel corona virus, scientists and doctors are constantly discovering new properties of the disease that the virus causes.
In addition to the lungs, the virus is said to affect the central nervous system, as Business Insider recently reported.
Now there are other deadly symptoms such as blood clots that doctors don’t know how to treat.
Dr. Alex Spyropoulos focuses on one question when it comes to patients who suffer from COVID-19: When doctors give therapeutic doses of blood-thinning heparin, these doctors save the lives of people who Corona virus are sick? Spyropoulos, an expert in blood clots at Northwell Health Hospital in New York, says that’s the most important question he has come across in his career.
With the spread of the coronavirus pandemic, which infects millions and kills hundreds of thousands worldwide, doctors have had to quickly find out how to treat patients without a vaccine or medication to cure them. For example, they are still not sure how best to bring oxygen into the damaged lungs of seriously ill patients.
And now they’re learning that respiratory disease affects more than just the lungs, especially in severe cases. Doctors have reported kidney problems, heart problems, and more recently, problems with blood clots that occur in different parts of the body. A study from Wuhan also indicates that the coronavirus is also the central nervous system concerns.
Typically, doctors like Spyropoulos prefer to rely on the results of robust clinical trials to find out whether treatments are effective. But because the virus is so new, the studies are just beginning. The results are expected in the coming months. “We fly blind, based on the data that we describe as very weak but very convincing,” says Spyropoulos.
In the absence of solid scientific evidence to show whether one approach or another is the best, doctors are discussing the best way to treat the disease. Studies are currently underway looking for the answer to Spyropoulos’ question and investigating whether anticoagulant drugs – which are usually used to treat stroke – are a good approach.
“Remarkably high” clotting frequency in COVID-19 patients
Already at the beginning of the coronavirus outbreak, doctors in the United States heard from colleagues in China about the effects of the virus on the heart, said Dr. Thomas Maddox, chair of the American College of Cardiology’s Science and Quality Committee, told Business Insider.
The effects appeared to be related to both viral heart invasion and stress in fighting respiratory disease. With COVID-19, doctors also see blood clots in patients’ lungs and bodies, said Dr. Greg Martin, professor of pulmonary medicine at Emory University and president of the Society of Critical Care Medicine, told Business Insider.
Clots can destroy the body because they block veins, for example, which leads to strokes, heart attacks, kidney problems, lung problems and much more.
Blood clots are not uncommon in critically ill patients in intensive care units or even in hospital stays. In the intensive care unit, patients are usually ventilated and sedated, which limits their ability to move during healing – good prerequisites for the formation of the blood clot.
Other viruses also increase the risk of blood clots
However, doctors suspect that the virus could also play a role in increasing the risk of clotting.
“We think this is one of the major, if not the most important issue in monitoring sick COVID-19 patients in the hospital,” said Spyropoulos. It wouldn’t be the first time, he said. Doctors found an increased risk of coagulation in patients with H1N1 or swine flu and in the SARS outbreak.
In a recent observational study, Dutch researchers examined 184 corona patients in the intensive care unit. About a third of them had a complication associated with a blood clot, such as blood clots in the lungs, blood clots in the legs, a stroke, heart attack, or other blood clots that cut blood to other parts of the body.
All have been treated preventively to prevent clotting in the body.
This is a higher rate of problems than they normally experience in ICU patients, Spyropoulos said. Typically, he said, coagulation rates in intensive care units are between 5 and 10 percent for various conditions. The researchers called the latest numbers “remarkably high” and recommended increasing the doses of the blood-thinning drug.
To find out how best to treat patients, researchers are now considering two options:
- Heparin, a blood thinner that prevents coagulation complications in patients.
- Anticoagulant drugs that are usually used to treat strokes.
Make decisions when there is no evidence
At the moment, most of the evidence doctors use is not much more than anecdotes. The ACC is currently evaluating recommendations for the treatment of the coagulation complications observed in COVID-19 patients, but cardiologists will not have much evidence to make informed decisions until they are expected to receive clinical trial results in the second half of this year.
“Our journals are essentially flooded with opinions,” said Dr. Thomas Maddox.
To avoid coagulation complications in COVID-19, Northwell Hospital’s Spyropoulos relied on its clinical experience to make decisions. “If you have a lot of experience in this area, you can make reasonable assumptions and extrapolations and observations from indirect data,” said Spyropoulos.
In the past month, partially while he was suffering from COVID-19, he has worked with the health care system to adjust guidelines, increase preventive dosing of blood thinners and ensure that doctors are more sensitive to signals that may indicate clotting, such as swelling in the patient’s legs.
The health system has also monitored signs of clotting when patients leave the hospital and prescribed blood thinners when patients are discharged.
Complications outside of hospitals
At the moment, researchers and doctors are mainly concerned with what to do with blood clot complications in hospital patients. But, Spyropoulos says, there are two additional questions he is keeping an eye on.
One is whether coagulation complications occur in milder COVID-19 cases that do not require hospitalization. This question is far from being answered, especially given the lack of available routine tests.
The other question is whether blood clots cause problems after COVID-19 patients leave the hospital, which could lead to sudden deaths. Spyropoulos said he was concerned about complications after the patient was discharged. In early Northwell autopsy data, 40 percent of patients who died after leaving the hospital appeared to have had serious clotting events, such as a massive heart attack or lung clot.
This article has been translated from English. Here you read the original.