COVID-19 and Lung Blood Clots: Link Elucidated
In the ongoing battle against COVID-19, a new concern has emerged: the increased risk of pulmonary embolism (PE), a potentially life-threatening condition. Studies have shown that this complication is particularly prevalent in severely ill patients [1][3][4].
Research indicates that the highest risk of PE with COVID-19 is among those with severe infections or those hospitalised due to the infection. The exact cause remains unclear, but it's believed that COVID-19 triggers a hypercoagulable, prethrombotic state, leading to thrombosis in both micro- and large vessels [3][4].
A German ECMO registry study reported PE in 19% of COVID-19 patients treated with ECMO, highlighting a high thrombosis burden in critical illness [1]. Systematic reviews and meta-analyses involving tens of thousands of patients have found an overall thrombotic event rate of approximately 21%, with PE occurring in around 8% [3][4].
Thrombotic events, including PE, are especially prevalent among critically ill patients in intensive care units (ICU), leading to higher mortality rates [3][4]. The underlying mechanism involves COVID-19-induced endothelial damage, inflammation, and coagulation activation, resulting in a "vascular nightmare" with both arterial and venous thromboses [3][4].
Clinical management includes anticoagulation therapy, with ongoing research to optimise prevention and treatment strategies to reduce thrombotic complications and improve survival [3][4]. When imaging is not possible, healthcare professionals should start anticoagulant therapy in people with COVID-19 and a higher risk of deep vein thrombosis (DVT) [5].
However, it's important to note that people not hospitalised for COVID-19 should not receive anticoagulant therapy [5]. The National Institutes of Health's Antithrombotic Therapy in Patients With COVID-19 guidelines recommend that healthcare professionals do not perform routine screenings for thrombotic events in people without signs or symptoms of the condition [6].
People already taking anticoagulant medication for other conditions may have a protective effect against PE due to COVID-19 [2]. It's crucial for healthcare professionals to review all medications to prevent interactions before adding anticoagulant medications to a patient's treatment plan.
Pulmonary embolism is the leading cause of cardiovascular-related death in the United States. The average life expectancy following a pulmonary embolism can vary, with a score of 65 or less on the pulmonary embolism severity scale meaning a person has a 1-6% chance of dying within 30 days, and a score of 125 or more meaning a person has a 10 to 24.5% chance of dying within 30 days following a pulmonary embolism [7].
In summary, pulmonary embolism is a frequent and serious complication of COVID-19, especially in severely ill patients, driven by COVID-19-associated hypercoagulability and vascular injury. Studies emphasise the need for vigilant thrombosis monitoring and appropriate anticoagulant treatment in these patients [1][3][4].
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- A holistic approach to health and wellness that encompasses factors like adequate sleep, nutrition, exercise, mental health, and smoking cessation will be crucial for individuals managing the long-term impact of COVID-19 on their bodies and minds.
