Countering COVID – A 5-part Review by Colin Rose October 2020 Part 1 Sticky Blood

Colin Rose, the author of this series of articles, is a Senior Associate of the Royal Society of Medicine (RSM). He draws on recent updates from multiple sources including both the US and European Centres for Disease Prevention and Control. He researches and writes for Uni-Vite Healthcare Ltd.

In this new five-part series, the emphasis is both on how to improve your chances of a mild outcome and evidence-based ideas for prevention.


Countering COVID Part 1 – The Risk of Sticky Blood

 

COVID-19 is more a blood clotting disorder than just a bad form of lung infection

SARS-CoV-2 was initially presumed to be primarily a bad form of acute lung injury. It is now classed more as a thrombotic [clotting] disorder – which is unusual in viral infections. What determines its severity is the degree of blood clotting – which potentially leads to stroke and heart attacks. The clots also threaten an increased risk of neurological complications like memory problems and confusion.

Clotting in small arteries leading to kidneys, lungs and heart

The most usual clotting triggered by COVID -19 is in small arteries that carry blood into organs like the kidneys, lungs, or heart. Blood clots in the veins often present in the legs (deep vein thrombosis) and are then dislodged into the lungs (called pulmonary embolism).

This restricts blood flow and oxygen to the heart and or brain and can be fatal. It is the lack of oxygen in the blood that meant so many hospitalised people in the early days were on ventilators. And why a long-term effect of Covid-19 is reduced lung capacity.

It is this clotting that is also one of the biggest COVID risks for people under 50.

Clotting linked to inflammation and immune system overdrive – cytokine storm

The clotting is linked to body-wide inflammation which characterises severe COVID-19 cases. In turn this inflammation is often triggered by what is called a “cytokine storm” . This happens when the immune system goes into overdrive and floods the body with cytokines (proteins involved in immunity). These cause devastating levels of inflammation that can lead to organ failure and death.

Treatment with anticoagulants

As a result, hospitalised COVID-19 patients are now regularly treated with anti-coagulants – medications that help prevent clotting and help blood to flow more freely. These include warfarin and heparin which may have an additional anti-viral effect by inhibiting a key protein the virus uses to latch onto cells.

To guide decisions about the level of anticoagulant doses, many centres are using a lab blood test that measures protein fragments called D-dimers, which are released into the blood when clots are present. These have become markers for the likely severity of coronavirus outcomes.

Testing – including the “D-dimer Test”

If you develop symptoms, the most important thing you can do is to get tested for COVID-19 and talk to your doctor about potential treatments, including blood thinning medication. In addition, if you test positive and are in a high-risk category, but below the level of symptoms that call for hospital admission, your doctor may include a D-dimer test in any blood work.

Actions to decrease blood clot risk

The blood clotting risks of COVID-19 have implications for everyone – whether for prevention or faster recovery. These actions will decrease your risk:

1. Keep moving. Daily exercise like walking can help prevent and even actually dissolve blood clots – according to research at the University of Colorado Medical School.

2. Eat plenty of natural blood thinner foods. These include Omega 3 from oily fish, ginger, curcumin from turmeric, garlic, cayenne pepper, almonds and whole grains for their vitamin E. Grapeseed extract is also a supplement with known blood thinning properties.

But note that, although curcumin is one of the very best anti-inflammatory supplements for all-round health, if you are already on warfarin you should not take curcumin without talking to your doctor. Curcumin enhances the effect of warfarin and could cause a drop in blood pressure.

3. Lose weight. Obesity increases blood clotting risk.

4. Consider low dose aspirin during the pandemic.
The US National Institutes of Health are now pointing out that aspirin has the triple effects of inhibiting virus replication, acting as an anticoagulant and as an anti-inflammatory. They say:

“The early use of aspirin in covid-19 patients, which has the effects of inhibiting virus replication, anti-platelet aggregation, anti-inflammatory and anti-lung injury, is expected to reduce the incidence of severe and critical patients, shorten the length of hospital duration and reduce the incidence of cardiovascular complications”.

Whilst low dose aspirin – 75mg a day – can increase the risk of intestinal bleeding, it is worth asking your doctor about her or his advice on using aspirin preventively. But please don’t self-medicate without checking first.

References

1. nhlbi.nih.gov/news/2020/sticky-net-substance-may-cause-life-threatening-clotting-lungs-covid-19-patients
2. bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/is-coronavirus-a-disease-of-the-blood-vessels
3. pharmaceutical-journal.com/news-and-analysis/features/everything-you-need-to-know-about-the-covid-19-therapy-trials/20208126.article?firstPass=false