Blood clotting a significant cause of death in patients with COVID-19

Findings reveal an association with a unique type of blood clotting disorder that primarily focuses within the lung and contributes to higher levels of mortality in coronavirus cases.

This shows a blood vial and covid19
The authors found that abnormal blood clotting occurs in Irish patients with severe COVID-19 infection, causing micro-clots within the lungs. Image is in the public domain.

Summary: Abnormal blood clotting contributes to death in some patients with severe COVID-19 infections. The abnormal blood clotting caused micro-clots within the lungs. Those with higher levels of blood clotting activity were significantly more likely to require ICU admission. Findings reveal an association with a unique type of blood clotting disorder that primarily focuses within the lung and contributes to higher levels of mortality in coronavirus cases.

Source: RCSI

A study led by clinician scientists at RCSI University of Medicine and Health Sciences has found that Irish patients admitted to hospital with severe COVID-19 infection are experiencing abnormal blood clotting that contributes to death in some patients.

The study, carried out by the Irish Centre for Vascular Biology, RCSI and St James’s Hospital, Dublin, is published in current edition of the British Journal of Haematology.

The authors found that abnormal blood clotting occurs in Irish patients with severe COVID-19 infection, causing micro-clots within the lungs. They also found that Irish patients with higher levels of blood clotting activity had a significantly worse prognosis and were more likely to require ICU admission.

“Our novel findings demonstrate that COVID-19 is associated with a unique type of blood clotting disorder that is primarily focussed within the lungs and which undoubtedly contributes to the high levels of mortality being seen in patients with COVID-19,” said Professor James O’Donnell, Director of the Irish Centre for Vascular Biology, RCSI and Consultant Haematologist in the National Coagulation Centre in St James’s Hospital, Dublin.

“In addition to pneumonia affecting the small air sacs within the lungs, we are also finding hundreds of small blood clots throughout the lungs. This scenario is not seen with other types of lung infection, and explains why blood oxygen levels fall dramatically in severe COVID-19 infection.

“Understanding how these micro-clots are being formed within the lung is critical so that we can develop more effective treatments for our patients, particularly those in high risk groups.

“Further studies will be required to investigate whether different blood thinning treatments may have a role in selected high risk patients in order to reduce the risk of clot formation,” Professor O’Donnell said.

Emerging evidence also shows that the abnormal blood-clotting problem in COVID-19 results in a significantly increased risk of heart attacks and strokes.

About this COVID-19 research article

Source:
RCSI
Media Contacts:
Press Office – RCSI
Image Source:
The image is in the public domain.

Original Research: Closed access
“COVID‐19 Coagulopathy in Caucasian patients”. by Helen Fogarty et al.
British Journal of Haematology doi:10.1111/bjh.16749

Abstract

COVID‐19 Coagulopathy in Caucasian patients

Although the pathophysiology underlying severe COVID‐19 remains poorly understood, accumulating data suggest that a lung‐centric coagulopathy may play an important role. Elevated D‐dimer levels which correlated inversely with overall survival were recently reported in Chinese cohort studies. Critically however, ethnicity has major effects on thrombotic risk, with a 3‐4 fold lower risk in Chinese compared to Caucasians and a significantly higher risk in African‐Americans. In this study, we investigated COVID‐19 coagulopathy in Caucasian patients. Our findings confirm that severe COVID‐19 infection is associated with a significant coagulopathy that correlates with disease severity. Importantly however, Caucasian COVID‐19 patients on LMWH thrombo‐prophylaxis rarely develop overt DIC. In rare COVID‐19 cases where DIC does develop, it tends to be restricted to late stage disease. Collectively, these data suggest that the diffuse bilateral pulmonary inflammation observed in COVID‐19 is associated with a novel pulmonary‐specific vasculopathy which we have termed pulmonary intravascular coagulopathy (PIC) as distinct to DIC. Given that thrombotic risk is significantly impacted by race, coupled with the accumulating evidence that coagulopathy is important in COVID‐19 pathogenesis, our findings raise the intriguing possibility that pulmonary vasculopathy may contribute to the unexplained differences that are beginning to emerge highlighting racial susceptibility to COVID‐19 mortality.

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