Editor’s note: Our understanding of COVID-19 symptomatology is evolving as the current pandemic unfolds. The International Society on Thrombosis and Haemostasis has collected a number of studies and case reports on thrombosis in COVID-19 patients. The Journal of American College of Cardiology released a review of current understanding, citing many of the studies and case reports which are on the ISTH site. This COVID-19 pandemic challenges us to use current knowledge and innovate new approaches to care for patients diagnosed with COVID-19. This article seeks to summarize some of the current knowledge about thrombosis in COVID-19 patients, knowing that future studies and case reports will undoubtedly refine the statements made below. However, this is science, continually evolving and improving based on current understanding. With that, this article offers some insights about VTE in patients admitted to the hospital who have been diagnosed with COVID-19.
By Michael Wong (Founder/Executive Director, Physician-Patient Alliance for Health & Safety), Laurie Paletz, BSN PHN RN BC SCRN (Manager, Stroke Program Department of Neurology, Cedars-Sinai), and Thereza B. Ayad, RN, MSN, DNP, CNOR (Assistant Professor, University of Massachusetts Medical School-Graduate School of Nursing; Surgical Services Clinical Staff Educator, North Shore Medical Center)
(reviewed by Sue Koob, MPA, Chief Executive Officer, Preventive Cardiovascular Nurses Association and Pat Salber, MD, MBA, Editor-in-Chief, DoctorWeighsIn)
There have been reports about the development of venous thromboembolism (VTE) in patients with COVID-19. Such reports highlight a lack of awareness of evidenced-based best practices in managing VTE in patients diagnosed with COVID-19, patients at risk of developing COVID-19, and patients who are currently on anticoagulant therapy for other chronic medical conditions.
However, hypothesizing a solution to a high criticality problem like COVID-19 may result in harm and death: Massachusetts General Hospital in its hematology guidance for COVID-19 patients cautions against the administering tPA, saying, “currently, there is insufficient data to suggest using more advanced therapies (such as tPA) in critically ill COVID-19 patients and we do not recommend it at this time.” (tPA is commonly referred to as a “clot buster” and is administered intravenously for ischemic or thrombotic stroke.) The LA Times reported that a doctor in New York, “took a gamble” by administering “a low-dose drip of tPA for about 24 hours, together with a blood thinner.” While this bought the patient “a few more days of life. A sudden, different complication killed her” a few days later.
The LA Times article notes that whether the doctor’s actions were correct or not, it is all guesswork without sufficient evidenced-based practices:
“We’re taking care of extremely ill patients that are dying in front of us, and we can’t get any diagnostic testing, yet still have to make treatment decisions,” said Dr. Steven Pugliese, a pulmonologist at the University of Pennsylvania.
Our understanding of COVID-19 symptomatology is evolving as the current pandemic unfolds. However, there are current studies and patient case reports that provide us some insights about VTE in patients admitted to the hospital who have been diagnosed with COVID-19.
To read the article published on the DoctorWeighsIn, please click here.
As a patient, you may have questions, particularly during the current COVID-19 pandemic:
- If I have been diagnosed with a cardiovascular disease, am I more at risk of getting COVID-19?
- If I’m taking an anticoagulant, does this increase my risk of getting COVID-19?
- If I go to the hospital to get treated, will I just get infected by COVID-19 there?
For these and other questions, the Physician-Patient Alliance for Health & Safety recently launched a free online service (the CV Virtual Clinic) where patients can speak with experienced registered nurses and get personalized answers to their questions.
The CV Virtual Clinic has been made possible by the generous grant support of BMS-Pfizer Alliance, as well as the efforts and resources of the American Heart Association, AC Forum, Heart Rhythm Society, StopAfib.org, Mended Hearts, and Preventive Cardiovascular Nurses Association. To read more about it, please click here.
In an article published on the Society of Hospital Medicine’s publication, The Hospitalist, here is what was written about COVID-19–associated coagulopathy: “Coagulopathies associated with COVID-19 infections have been documented in several studies around the world, and it has been shown to be fatal in some cases. Despite documentation, the mechanism behind this coagulopathy is not well understood. Because of the potentially lethal complications associated with coagulopathies, early recognition and anticoagulation is imperative to improve clinical outcomes.” – https://www.the-hospitalist.org/hospitalist/article/221875/coronavirus-updates/covid-19-associated-coagulopathy/page/0/1?channel=63993