Are BLOOD CLOTS the reason why COVID patients are dying? | Blood thinners to save lives?

I can tell you that the number of clotting problems my colleagues see in the ICU across the country, all related to Covid, is unprecedented. But this isn’t just a bunch of doctors and nurses that I know who are reporting this. For example, a recent Dutch study found that of the 184 patients in the ICU with Covid pneumonia, 20% had clotting issues.

There was also a similar study in Wuhan, China, where 25% of hospitalized COVID patients had clots. So why, and how is SARS-CoV-2, which invades the lungs' cells, specifically type II alveoli, how is it causing blood clots to form in the body? When someone has a severe case of COVID, it causes a ton of inflammation within the lungs. This inflammation is what is triggering the blood clots to develop.

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We knew that this happens with ARDS even before COVID came around. In ARDS, these patients usually develop microthrombi, meaning tiny clots that form in the tiny blood vessels in the lungs. And these microthrombi can combine to form bigger thrombi, meaning bigger clots.

This happens at least partly because of the cytokine storm that develops as a result of the infection. Blood clots are also a concern with seriously ill people in general, regardless of their illness. These patients aren’t moving much, if at all, and lack of movement further predisposes one to have clots.

And that’s why when patients are admitted to an intensive care unit, we usually have given them blood thinners unless there is a reason not to; for example, if they have to bleed, we don’t want to give those patients blood thinners. But when we give these blood thinners, we give them in prophylactic doses, meaning the intention is to reduce their risk of developing a clot in the first place.

But these prophylactic doses are considered low doses. And the chances of someone having severe bleeding from these small doses are minimal. But the blood clots with COVID, these are just a whole ‘other beast.

There’s something more going on here. So how, and why is COVID causing more blood clots than usual?

Long story short, the virus enters the alveolar cells in the lungs using the ACE2 receptor, and once it does that, it causes the cell to have fewer ACE2 receptors on its surface. This increases the amount of 3 things within the lungs:
1) inflammation,
2) formation of clots, and
3) constriction of blood vessels going to the lungs, meaning pulmonary vasoconstriction.

And guess what, each of these things by itself can lead to low oxygen levels. So you can imagine what that means when you have all 3 of these things going on simultaneously. This is because the way oxygen gets into our blood from the alveoli has to diffuse to our capillaries.

The cytokine storm causes the destruction of the alveolus and the endothelium, a trigger for clotting. We knew this happened in ARDS even before COVID. But guess what, the virus that causes COVID can actually invade the cells here in the endothelium because these cells have ACE2 receptors as well. And that can cause even more inflammation and more clotting.

And these clots can combine with other clots to form bigger clots and travel to other body parts. And in another published report in the NEJM, 3 patients in the ICU had COVID, and these 3 patients developed blood clots that were significant enough to cause major blockages in blood vessels. These 3 patients were positive for antiphospholipid antibodies. These antibodies are not in the blood of the vast majority of people.

These antiphospholipid antibodies are bad because they attack phospholipid proteins in our body, and if severe enough, they can cause major clots to form in our blood vessels. Anti-phospholipid antibody syndrome is a condition that depends on someone’s genetics. But these antibodies can also arise transiently in patients with critical illnesses and various infections.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
Website: https://doctormikehansen.com/
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