Fatal blood clotting and the COVID-19 connection

Deadly blood clotting complications were identified as an emerging threat in COVID-19 patients and recognised as a clear target to reduce fatalities in the global pandemic, according to a Baker Institute review paper published over the weekend.

The paper points to recent clinical data showing COVID-19 is associated with a significant risk of the formation of blood clots and resulting deadly complications like deep vein thrombosis, pulmonary embolism and stroke.

Senior author cardiologist Professor Karlheinz Peter and his colleagues, haematologists Dr James McFadyen and Dr Hannah Stevens from the Atherothrombosis and Vascular Biology Laboratory at the Baker Institute, say emerging data show clotting complications were markers of severe COVID-19 and are associated with multi-organ failure and a dramatically increased risk of death.

“In serious cases COVID-19 was initially considered to primarily affect the respiratory tract by causing pneumonia and acute respiratory distress syndrome. It has now become apparent that it’s also associated with abnormality of blood coagulation causing highly dangerous, often fatal, blood clots,” says Professor Peter.

“That means it’s critical we understand the drivers causing this abnormal coagulation. Evidence to date supports the concept that the blood clotting in patients with severe COVID- 19 is due to the ability of the coronavirus to invade cells in blood vessel walls via angiotensin-converting enzyme 2 — known as ACE2.

“The body’s subsequent immune response, and the inflammation this causes triggers the blood clotting in an unholy trinity that we must disrupt.”

The Atherothrombosis team noted that a number of blood thinning treatments are now being proposed in COVID-19 treatment.

“Given blood clotting is associated with a substantially higher risk of fatal outcomes in COVID-19 patients its prevention is of critical importance,” says Professor Peter.

“It’s important there is early and stringent testing for blood clotting complications, and anticoagulation drugs are administered as early as possible for both the prevention and treatment of clotting.”

The paper overview, published in the international journal Circulation Research, provides the strong message that there is a clear diagnostic and therapeutic path that can be taken to reduce thrombotic complications and thereby avoid a substantial number of fatalities from COVID-19, especially in the absence of an available vaccine or treatment for the virus.

“As the pandemic continues to unfold it is clear further research is urgently required to better define how SARS-CoV-2 infection results in clotting complications and how this impacts the course the disease takes and its severity,” says Professor Peter.

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