PHN Explores: Blood thinners show promise for boosting the survival chances of the sickest covid patients (From The Washington Post)
PHN Content By Mat Edelson
If We Had Written the Headline
Study of 395 Covid-19 patients on ventilators suggests blood thinners may increase survival rates for seriously ill cases
Why You Should Care
If you’ve ever had a blood clot, you know how tricky it can be to treat, and how balancing between too little and too much blood-thinning (aka, “anticoagulation”) medication is crucial. That’s because overly-thinned blood can cause internal bleeding. Doctors are wondering where that fine line of anticoagulation treatment is with Covid-19, because the virus can cause dangerous blood clots in severe cases. This study gives clinicians the first inkling of doses that may be both effective and relatively safe for Covid-19 patients on ventilators.
ICU doctors are noting an unusually high number of blood clots in seriously ill and ventilated Covid-19 patients (see our “Deeper Dive” section below). Even patients already on blood thinners are having clots. Breaking up these blood clots is critical; they can kill if they lodge in the lung, heart or brain. However, giving large amounts of anticoagulants can cause internal bleeding. Without studies to guide treatment, clinicians are in a bind; they’re forced to rely on their experience and their gut, which isn’t the ideal way to treat victims of a new illness.
This study offers insights into a potential course of blood clot care. Researchers went back through the medical records of 395 New York City patients hospitalized with Covid-19 between March 14 and April 11. They were all on ventilators. 63% of the group receiving no blood thinners died during their hospitalization. The group receiving anticoagulation therapy fared far better; Just 29% of this group died while hospitalized*. Clearly that’s quite a difference, though unknown factors might be influencing the numbers.
The study also found that the anticoagulated patients didn’t have a large number of “bleeding events.” The researchers are cautious here because it wasn’t a randomized trial. Still, one of the study’s authors at Mount Sinai Hospital told the Washington Post the hospital’s health system changed its drug protocol because of the study, and certain Covid-19 patients will now receive higher levels of anticoagulants.
Unfortunately, in another part of the study that looked at 2378 Covid-19 patients not on ventilators, there was essentially no difference in the death rate between patients who receved anticoagulation therapy and those who did not.
(*numbers were rounded to eliminate decimals)
See The Story
Blood thinners show promise for boosting the survival chances of the sickest covid patients, Washington Post, May 7, 2020, By
Dr. Mitchell Elkind, a professor of neurology at Columbia University College of Physicians and Surgeons, attending neurogologist on the stroke service at NewYork-Presbyterian Hospital
Here’s an excellent, extensive video interview with Dr. Elkind that covers many of the ways Covid-19 may affect the body (We emphasize may, since, as Dr. Elkind repeatedly notes, doctors are making these real-time observations in just a few patients, so no conclusions can be drawn without further study). Since Elkind’s interviewer is with a medical publication, there’s some jargon involved, but Elkind is very good at explaining things in a way any of us can understand. As a side note, Elkind is the president-elect of the American Heart Association. (Interview courtesy of Practical Cardiology, entitled “Increased risk of stroke and seizure in Covid-19 patients.”)
For a good round-up on Covid-19 and anticoagulation treatment, we suggest this story from STAT (A Boston Globe Media science and medicine news website): Giving blood thinners to severely ill Covid-19 patients is gaining ground
Here’s a link to a PDF download of the Mount Sinai study in the Journal of the American College of Cardiology: Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19
Here’s a Dutch study that found a high number of blood clots in Covid-19 patients. From the journal Thrombosis Research: Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis