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The coronavirus COVID-19 appears to promote blood clotting throughout the body, which could help explain why it is much more deadly than other members of its viral family, experts say.
Doctors have observed that some seriously ill people with COVID-19 develop blood clots in their lungs and other major organs.
Doctors suspect these small blood clots are one of the reasons why COVID-19 patients struggle to breathe, said Dr. Hooman Poor, a lung and critical care physician with Mount Sinai Beth Israel in the city of NY.
“We don’t just see the possibility of blood clots in the lungs,” said Poor. In COVID-19 patients requiring dialysis due to kidney failure, “their catheters are coagulating every second.”
These small blood clots could also be responsible for one of the only COVID-19 symptoms: suddenly loss of smellsaid Dr. Jeanne Marrazzo, professor of infectious diseases at the University of Alabama at Birmingham. It could also explain why patients who appear well are suddenly blocked.
The coagulation associated with COVID-19 is so pronounced that “some people start saying, ‘Look, anyone who comes to the hospital needs to be put on blood thinners’ at the beginning of their treatment,” said Dr. Carlos del Río: Professor of infectious diseases at Emory University in Atlanta.
The poor recently treated five critically ill patients with COVID-19 with tPA, an anticoagulant drug normally used in stroke patients, according to a new preliminary case report from the Icahn School of Medicine at Mount Sinai.
All five patients had respiratory failure early in their illness, along with blood oxygen levels and clot-related protein markers that indicated that blood clots in the lungs could deprive them of breathing, Poor and colleagues noted. .
“The first patient I gave it to had a dramatic and immediate response, indicating that blood clots were definitely playing a role in why she was so ill at the time,” said Poor.
All five showed immediate improvements in their blood oxygen levels, but ultimately failed, Poor said.
However, he believes that more research is needed before regularly treating patients with COVID-19 with anticoagulant or anticoagulant drugs.
“They are both very dangerous medicines,” said Poor. “It would be a shame to administer these medications inappropriately and then have a bad result, such as catastrophic bleeding.”
Poor and his colleagues suspected that blood clots may be contributing to acute respiratory distress syndrome (ARDS) because the lungs of COVID-19 patients do not develop the type of stiffness that is generally seen in other viruses that make breathing difficult.
“When you have these abnormalities in oxygen and carbon dioxide with lungs that are not particularly stiff, the first thing that occurs to you is that there is something wrong with the blood vessels in the lungs,” Poor said.
Others have also observed clots with COVID-19. Dutch researchers found that about a third of 184 patients in intensive care with coronavirus had a complication associated with a clot, in the lungs or legs, or even as serious as a stroke or heart attack, according to their report on 10 September. April Thrombosis investigation.
Lung blood clots generally occur because a large blood clot in the leg, a deep vein thrombosis, is released and travels to the lungs, Marrazzo said.
But it is not unusual for viruses to promote blood clots, del Río said. For example, HIV can promote clotting in patients.
It is not yet known why the new coronavirus could promote blood clotting.
Poor and Marrazzo speculated that the virus somehow damages human cells in a way that promotes clotting. Poor noted that COVID-19 patients have elevated levels of D-dimer, a small protein fragment produced by blood clots.
Another recent study in the magazine. Physiological reviews He noted that people with already high levels of plasmin, a key enzyme that breaks down blood clots, tend to have a more severe COVID-19 infection.
Plasmin appears to help the new coronavirus more easily bind with human cells, said lead investigator Dr. Hong-Long Ji, professor of cell and molecular biology at the University of Texas Health Sciences Center at Tyler .
If this is true, the use of blood-thinning medications to treat COVID-19 could backfire by improving patients’ infection, Ji said.
“If you give the patient plasmin or another type of protein to get rid of clots, then the problem is that this patient still has a virus in his body and he also has a bleeding problem in all kinds of major organs,” Ji said.
