- We are still learning about all terrible the things new coronavirus done to human bodies. Doctors aren’t sure how best to treat it.
- In the sickest patients with COVID-19, the disease caused by the coronavirus, the disease affects more than the lungs.
- Doctors have reported kidney problems, heart problems, and unusually high blood clots in critically ill patients.
- Doctors do not know how to treat blood clots. Some are offering large doses of blood thinners, while others are exploring anti-clot drugs otherwise used to treat stroke.
- Trials to assess whether these options are helping patients recover are underway, but the results are still months away, leading doctors to make their own decisions.
- Visit the Business Insider home page for more stories.
Dr. Alex Spyropoulos focuses on a big question regarding critically ill patients with COVID-19, the disease caused by new coronavirus.
The question: if doctors administer therapeutic doses of anticoagulant heparin, do these doctors save the lives of patients with COVID-19?
Spyropoulos is a expert in blood clots at Northwell Health in New York, and he said that was the most important question he had encountered in the time he had spent in his field.
As the coronavirus pandemic spread, infecting millions around the world and killing hundreds of thousands, doctors were forced to quickly figure out how to treat it without a vaccine or the drugs that cure it. They are still not sure for example, the best way to get oxygen to the damaged lungs of the most seriously ill patients.
And now they learn that respiratory disease seems to affect more than the lungs, especially in severe cases. Doctors have reported kidney problems, heart problems and, more recently, problems with blood clots appearing in different parts of the body. Not helping the question, the researchers also have reported complications that could complicate blood clots in other COVID-19 hospitalized patients.
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Generally, doctors like Spyropoulos prefer to rely on the results of robust clinical trials to determine if the treatments are working. But because the virus is so new, testing is just beginning, with results expected in the coming months.
“We drive blindly on the basis of what we call very weak but very convincing data,” said Spyropoulos.
In the absence of solid scientific evidence confirming whether one approach or another is the best, doctors are debating the best way to treat the disease. Studies are underway to find the answer to Spyropoulos’ question, as well as to find out if anti-clot drugs – generally used to treat stroke – are a better approach.
“Remarkably High” Coagulation Incidence in Patients with COVID-19
At the start of the coronavirus epidemic, doctors in the United States heard colleagues from China talking about the effects of the virus on the heart, said Dr. Thomas Maddox, chairman of the scientific and quality committee of the American College of Cardiology . Insider.
The effects appeared to be related to both a viral invasion of the heart and the stress of fighting respiratory disease.
With COVID-19, doctors also observe blood clots in the lungs and bodies of patients on respirators, Dr. Greg Martin, professor of pulmonary intensive care at Emory University and president-elect of the Society of Critical Care Medicine, said Business Insider.
Clots can wreak havoc on the body, travel and block veins, leading to stroke, heart attack, kidney problems, lung problems, and more.
Blood clots are not uncommon in critically ill patients in intensive care units, or even in hospitalizations. During intensive care, patients are generally on respiratory assistance and sedation, which limits their ability to move during recovery. Standing still increases the risk of clots.
Other viruses also increase the risk of clots
But doctors have a feeling that the virus could also play a role in increasing the risk of clots.
“We believe that this is one of the most important, if not the most important, problem with regard to the surveillance of ill hospitalized COVID-19 patients,” said Spyropoulos.
With the new coronavirus, more clots appear to be from the lungs, said Spyropoulos.
In one recent observational study, Dutch researchers examined 184 patients in the intensive care unit with coronavirus. About a third of them had a complication associated with a clot, such as clots lungs, clots in the legs, stroke, heart attack, or other clots that cut blood to other parts of the body.
All were on preventive treatment to prevent clotting in the body.
This is a higher rate of problems than that which could be observed in patients in the intensive care units, said Spyropoulos. Typically, he says, coagulation rates in intensive care units for different conditions are between 5 and 10%. Researchers called it “remarkably high,” recommending increasing doses of the anticoagulant medication.
To find the best way to treat patients, the researchers are evaluating two options:
Make decisions in the absence of evidence
For now, most of the evidence that doctors use is not much better than anecdotes. The CCA is currently reviewing recommendations on how to manage the clotting complications seen in COVID-19 patients, but cardiologists will not have much evidence to guide them until they get the results. clinical trials, likely, in the second half of this year.
“Our journals are inundated primarily with opinion pieces,” said Maddox.
To prevent the complications of coagulation in COVID-19, Northwell’s Spyropoulos used clinical experience to make decisions.
“If you have extensive experience in this area, you can make reasonable assumptions and extrapolations and observations from indirect data,” said Spyropoulos.
Over the past month – partly in the event of illness with COVID-19 itself – he has worked with the health system to adjust guidelines, step up the preventive dosage of blood thinners and make sure doctors are more sensitive to signals that may indicate clotting, such as swelling in patients’ legs.
The health system also monitors signs of clotting after patients leave the hospital and prescribes blood thinners when patients are discharged.
Coagulation complications outside the hospital in COVID-19 patients
For now, most of the conversation has focused on what to do with the complications of blood clots in hospital patients.
But, said Spyropoulos, there are two other issues he keeps an eye on.
The first is whether coagulation complications occur in milder cases of COVID-19 which do not require hospitalization. This is an unanswered question, especially given the lack of routine tests available.
The other question is whether blood clots cause problems after COVID-19 patients leave the hospital, resulting in sudden deaths. Spyropoulos expressed concern about the complications that arose after the patients’ discharge. In Northwell’s early autopsy data, there appeared to be major clotting events such as a massive heart attack or pulmonary clots in 40% of patients who died after leaving the hospital.