COVID-19 is known as a disease that affects the lungs. Patients suffering from the illness caused by the coronavirus often have an intense cough and trouble breathing.
But another common, deadly and somewhat more mystifying complication happens in the blood, said Dr. David Dexter, a surgeon with Sentara Vascular Specialists.
Patients hit hard by the illness can bleed too easily or their blood has trouble clotting properly, he said. It can happen quickly and be life-threatening if not immediately addressed.
During the pandemic, Sentara has seen a significant uptick in surgeries to remove blood clots as well as thrombolysis, a treatment involving the injection of clot-busting drugs. That reflects a nationwide trend, Dexter said.
In severe cases of COVID-19, health care workers “almost consider it a cardiovascular virus,” he said. “The problem is that some of this disease has been silent.”
Normally, when someone shows up at the hospital from a vascular issue, there’s a swollen leg or some visible sign that prompted the visit, he said. But what he’s seen at Sentara is sometimes people show up with other severe COVID-19 symptoms, and it’s not until further inspection that “we find large burdens of clots.”
“They may not have had traditional symptoms. It just makes the treatment that much harder.”
A coronavirus patient’s blood vessels often shrink or form clots directly in blood vessels, including the essential arteries that carry blood to the heart. A blood clot can form in one of the deeper veins, often the legs, causing swelling or no symptoms. Pulmonary embolisms are also common, when blood clots get stuck in the lungs.
Hospitalized patients are already at a higher risk for clots because they’re less mobile. Therefore, hospitals often administer a small dose of blood thinners to people who come in no matter what, to ward off issues, Dexter said.
But blood clots have become so common in COVID-19 patients that Sentara had to decide whether to automatically up the dosage when doctors see those patients. The challenge is that some patients are having the opposite issue, bleeding more than usual, Dexter said.
“That’s a clinical conundrum on how we treat them.”
Right now, Sentara clinicians are taking it on a case-by-case basis, he said. They keep a close eye on coronavirus patients discharged from the hospital, trying to develop a personalized plan that could include blood thinners.
Dexter said he and his colleagues have been scouring national and international literature to keep up with how the virus works. Early research into the vascular impacts of COVID-19 have put forward different potential explanations for the connection. Some believe, for example, an autoimmune antibody circulates in the blood and attacks the cells, triggering clots.
Half of patients with severe COVID-19 were found to have heart damage months after discharge, according to a study out of London. Though Dexter said he can’t speculate on the why of the connection, there is clearly some sort of “biological pathway” that makes those infected with COVID-19 more prone to clots.
So what should people watch out for?
A swollen, discolored or painful leg can be a sign of a clot, as well as calf tenderness. Lung-related symptoms including chest pain or fatigue from walking a flight of stairs can be a potential sign of a pulmonary embolism.
Clogged vessels can also present as raised bumps, discoloration or swelling.
Dexter’s advice in all cases is to seek immediate medical care. Even nearly a year into the pandemic, he said some people appear to be putting off primary care, which he worries will lead to a “COVID hangover” of health problems.
Some patients who end up in emergency care weren’t diagnosed with COVID-19 until arriving at the hospital with seemingly unrelated issues. Others were asymptomatic but the clots were found in the course of their care.
Though the majority of patients Dexter sees as a vascular specialist do not have the coronavirus, seeing those who do is still a “daily occurrence.”
Just in the last week, that included a patient with a large pulmonary embolism, another whose intestinal arteries had been blocked off through clots and people with reduced blood flow in their legs from clots, which could’ve resulted in lost limbs.
Katherine Hafner, 757-222-5208, katherine.hafner@pilotonline.com
