Covid-19 infection and blood clots: How to prevent, identify and treat?

The ongoing global pandemic of coronavirus disease 2019 COVID19 may cause in addition to lung disease a wide range of nonrespiratory complications Among these thromboembolic complications due to abnormal clotting of blood in the arteries as well as veins present as an important issue and may occur in up to 3037 of COVID19 patients in the intensive care unit ICU These complications are found to occur during the period of actual illness as well as during the recovery period following the illness Itrsquos unclear exactly how COVID19 leads to blood clots However the infection has been found to activate various cells and molecules in the body that are involved in the clotting process Blood clots can develop in various organ systems of the body and presentation can vary depending on the organ system involved1Blood clots in arteries of legsarmsThe formation of blood clots in the arteries of the legs or arms can result in acute ischemia legarm attack Symptoms can include sudden onset pain in the legsarms cold limbs skin discoloration absent pulse loss of movementsensation and blackening of the toesfingersA CT angiogram can confirm the diagnosis and give an idea about the extent of blockages2 Deep venous thrombosisThrombosis of the deep veins of the legs is a common occurrence in Covid19 infected patients and presents as swelling pain and skin discoloration of the legs USG Colour Doppler test confirms the diagnosis of DVT A CT venogram may be advised to look for the proximal extent of the clots3 Blood clots in the lung arteriesBlood clots in the arteries of the lungs known as pulmonary thromboembolism present as severe chest pain increased difficulty in breathing and decreased oxygen saturation CT pulmonary angiogram can confirm the diagnosis of pulmonary thromboembolism Patients with DVT are more prone to develop pulmonary embolism as a clot from the veins of the legs can break off and travel to the arteries of the lungs4 StrokeStroke in Covid19 patients can happen due to the formation of blood clots in the arteries supplying the brain or in the veins draining blood from the brain Patients present with various symptoms such as weakness of arms and legs slurring of speech facial weakness giddiness imbalance and loss of consciousness CTMRI brain with angiogramvenogram helps to identify the brain damage and the blockages in the vessels of the brain5 Heart attackCOVID19related inflammation raises the risk of heart attack by activating the bodyrsquos clotting system and disrupting the blood vessel lining thereby causing blockages in the arteries of the heart Burning or tightening in the chest radiating to the arms and neck sharp stabbing chest pain unusual shortness of breath are some of the symptoms of a heart attack Timely diagnosis and intervention by a cardiologist are needed in these patients6 Blood clots in the intestinal arteriesBlood clots in the arteries supplying the intestines cause acute bowel ischemia Symptoms include severe abdominal pain vomiting diarrhoeaconstipation and blood in stools CT angiogram of the abdomen helps to identify the clots in the intestinal arteries7 Blood clots in the renal vesselsThrombosis of the renal arteries can cause sudden onset flank pain acute renal failure and decreased urine output Blood clots can also develop in the renal veins which can present as loin pain vomiting hematuria and decreased urine output A contrastenhanced CT scan identifies these blood clots and helps in treatment planningHow to PreventGuidelines suggest prophylaxis with bloodthinning agents for all hospitalized patients with COVID19 in the absence of contraindications such as active bleeding These blood thinners can be continued during the recovery period in patients with a high risk of developing clotting complicationsTreatment optionsTherapeutic anticoagulation with bloodthinning agents forms the mainstay of treatment of clotting complications If these complications are identified early a vascular specialist doctor can perform certain procedures to remove the blood clots A vascular interventional radiologist can offer mechanical thrombectomy intraarterial thrombolysis which are minimally invasive procedures performed through a pinhole These procedures rapidly clear the fresh thrombus and give early symptom relief as well as prevent longterm complications Timely interventions in these patients can be lifesaving and help to reduce mortality and morbidity significantly