COVID 19 & Hypercoagulability: Increased Risk of Stroke, Heart Attack, DVT

COVID 19 patients present with a various number of clinical manifestation which may range from being an asymptomatic carrier to severe respiratory failure, multiorgan failure and death.

Initially it was concluded that COVID 19 was a respiratory disorder only but now it is considered as a systemic illness due to the various number of complications and vulnerability of the patients who have associated co-morbid conditions.

Coronavirus
Coronaviruses infect animals, humans, and birds. Human coronaviruses, such as SARS, MERS, and 2019-nCoV cause respiratory distress and even death. The S protein is the infectious agent of the virus.

‘COVID 19 patients show an increased incidence of stroke , Heart attack and deep vein Thrombosis due to increased tendency of blood clotting. Hence all the COVID 19 patients should receive an anticoagulation therapy, dose depending upon the severity of the disease. This helps in reducing the morbidity and increases the chances of survival in critically ill patients.’

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Some studies have shown that COVID 19 patients have a very high chance of having an arterial or venous thrombus (clot formation in the blood vessels). Due to thrombus formation it was noticed that COVID 19 patients had an increased incidence of stroke, heart attack &formation of clots in the veins present in the arms and legs.

Consistently elevated D-Dimer in blood (small fragment of protein present in the blood when a clot starts degrading ) is an indicator of the problem and indicates that it can lead to complications including death.

The management of such increased tendency of blood clotting (or hypercoagulability ) is very challenging. It is now recommended to start blood thinners (intravenous Low molecular weight Heparin or LMWH) in all the acutely ill patients.

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Many physicians suggest starting an intermediate dose of LMWH 30-40mg twice daily subcutaneously or full-dose anticoagulation in critically ill individuals with COVID-19.

Due to lack of studies that are accepted universally, currently each of the hospital have a panel of doctors who discuss about the anticoagulation (blood thinner)therapy, hence this therapy differs from hospital to hospital.

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There are studies which have shown a higher mortality rate in patients who did not receive the anticoagulation therapy. High dose of blood thinners is required in ventilated COVID 19 patients. The dose of this anticoagulation therapy should be decreased in patients with underlying kidney disease or in patients undergoing dialysis.

Full dose anticoagulation therapy (LMWH 1gm/ kg twice a day) is recommended in COVID 19 patients with a history of heart attack, stroke or venous thromboembolism (formation of clots in the deep veins of the leg or arm).

Deep Vein Thrombosis (DVT) - Causes - Symptoms - Diagnosis - Treatment - Complications - Prevention
A blood clot (thrombus) in the deep venous system of the leg leads to deep vein thrombosis (DVT). DVT is a major cause of morbidity and mortality.

In the above mentioned patients the anticoagulation therapy should be continued for atleast three months post discharge. Oral Anticoagulation therapy (Tablet Rivaroxaban 10 mg ) is recommended for out patient prophylaxis.

Source-Medindia