I’m getting really tired of pandemics. I wish we could just move on. Sadly we can’t. It still here. That’s the truth. While I empathize with the protestors during this civil unrest, I fervently wish they all would wear masks, and if they can’t stay a meter apart, then at least wear gloves.
This week I discussed yet another thing to worry about with COVID infection. Blood clots. The good news is that most infected people do not have to worry about it as it’s mostly been described in hospitalized patients. But a combination of events have led to COVID infected patients having clots in both the venous and the arterial systems. Remember that veins take blood from the periphery to the heart, and arteries take oxygenated blood from the heart to the tissues. The Trifecta reason for clot formation is injury to the walls of the blood vessels (endothelial injury), stagnation of blood caused by immobility, and a hypercoaguable state (a condition in which blood clots too readily). The hypercoaguable state is documented by noting that many hospitalized patients have elevated levels of factors that promote clotting. (Factor 8, Fibrinogen, etc.).
Clots in the venous system leads to deep venous thrombosis or clots in the calf veins. Can be uncomfortable or asymptomatic. The problem is that if it dislodges from the calf, it can work it’s way to the right heart the the lung. That’s called a pulmonary embolism, which many times can be fatal. In fact autopsy studies from patients who succumbed to COVID in Wuhan as well as in the US, show evidence of large and small pulmonary emboli.
Clots on the arterial side are even worse. Remember this is the system providing nutrients and oxygen to the tissue. When a clot forms in this system, its lights out for the organ on the other side. You may have heard of COVID Toe Syndrome which was the “it” discussion a couple of weeks ago. Well, this is from arterial clots to those limbs. Worse is when a clot forms in the arterial supply to the brain. That, my friends, is called a stroke. Not good.
While it is not my intent to be a Debbie Downer and bring up more things that are horrible with the pandemic, it is important to educate. And to look on the bright side, if I can bring this information to bear, then we know that clinicians in the hospital are already aware of this and doing everything they can to prevent and treat these clots as they happen and prevent them from happening in the first place.
