20 May 2020

 Doctors in London say they have established a “clear link” between COVID‑19 and clotting of the blood, confirming previous studies suggesting significant impact on the cardiovascular system.

The team from the Royal Brompton Hospital revealed their insights, which remain unpublished, in an interview for the Sunday Telegraph.

The researchers have used CT scans to take images of the lungs in seriously ill patients, confirming the clotting of small vessels in the lung. Similar findings were reported by Irish researchers last month in the British Journal of Haematology.

Dr Brijesh Patel, an intensive care specialist and senior clinical lecturer at the Royal Brompton and Imperial College London, said : “These are very unwell patients but I think the majority of patients will end up on significant therapeutic doses of blood-thinning agents as we learn more about this disease. If these interventions in the blood are implemented appropriately, they will save lives.”

He added: “We’ve seen over 150 patients that have come through the Royal Brompton and having had a look at many of them over the past couple of months we’ve learnt a lot about them. We have the sickest cohorts of those in intensive care because of our extracorporeal membrane oxygenation service, which effectively is an artificial lung service where we take blood out of patients and oxygenate them outside their body.

“All these patients have perfusion problems seen in the tiny vessels of the lungs. Blood flow is decreased in these patients and it’s only visible from dual energy scans.”

Professor Peter Openshaw, specialist in experimental medicine at Imperial College London, said: “It does sort of explain the rather extraordinary clinical picture that is being observed with people becoming very hypoxic, very low on oxygen and not really being particularly breathless. That would fit with it having a blood vessel origin.”

A further study was published last week in the Journal of the American College of Surgeons by researchers at the University of Colorado Hospital, USA.

They report that early thromboelastography (TEG) testing might identify COVID-19 patients who are most at risk of renal failure, venous blood clots, and other complications associated with blood clots, such as stroke.

The US doctors now have a clinical trial of tissue plasminogen activator under way.

Researcher Dr Franklin Wright said: “These study results suggest there may be a benefit to early TEG testing in institutions that have the technology to identify COVID-19 patients who may need more aggressive anticoagulation therapy to prevent complications from clot formation.”


 

Source: Royal Brompton Hospital / University of Colorado. Link: https://www.rbht.nhs.uk/news/trust-researchers-forefront-covid-19-research   

Wright FL, Vogler TO, Moore EE, Moore HB, Wohlauer MV, Urban S, Nydam TL, Moore PK, McIntyre RC Jr. (2020) “Fibrinolysis Shutdown Correlates to Thromboembolic Events in Severe COVID-19 Infection”, J Am Coll Surg, doi: 10.1016/j.jamcollsurg.2020.05.007

 

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