COVID-19 Related Blood Clots Might be Silent Threats in Current Pandemic

Post by: Kainaat Khalil
May 24, 2021
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Governments around the world have implemented restrictive policies to reduce the COVID-19 transmission and aiming at keeping the mortality rate low. However, it is crucial to take into consideration that Stay-At-Home directives themselves can have adverse effects.

These include not only psychological effects but also physical issues including reduced physical activity and the accompanying consequences. The current pandemic has led us all too long hours sitting in front of our computers as we work from home or while homeschooling our kids. Then we retreat to the couch to hide from the news and watch an entire Netflix series without taking a break.

This unhealthy sedentary lifestyle is putting us all at an increased risk for developing blood clots such as deep vein thrombosis (DVT). DVT can be traced directly to the effects of Stay-At-Home directives.

In a case report published in the Interactive Journal of Medical Research in January 2021, Deep vein thrombosis as a result of Stay-At-Home directives had been reported. The only identified cause of DVT was reduced mobility due to preventive social isolation during the COVID-19 pandemic.

Klok et al. have also reported the incidence of thrombotic complications in 184 COVID positives (ICU) patients in the Netherlands. COVID-19 may predispose to both venous and arterial thromboembolism due to immobilization, excessive inflammation, diffuse intravascular coagulation, and hypoxia.

Khan et al. reported that COVID-19 patients are at increased risk of thrombosis for many reasons including immobility, inflammation, and factors contributing to a hypercoagulable state. Based on a retrospective study Karaali (2021) has also reported that COVID-19 confinement seems to be associated with increased rates of DVT.

Healy et al. had also provided evidence that computer-related seated immobility and prolonged work; defined as immobility for at least 10 hours within 24 hours and at least 2 hours at a time without getting up is a risk factor for venous thromboembolism that includes both DVT and pulmonary embolism.

Have you ever heard about deep vein thrombosis?

Well, it is the formation of a blood clot (thrombus) in a deep vein, most commonly in the legs or pelvis that can completely or partly block the blood flow through the vein. The life-threatening concern with DVT is the potential for a clot to embolize, travel as an embolus, and become lodged in a pulmonary artery that supplies blood to the lungs.

This is pulmonary embolism (PE) which requires immediate medical attention. Many people are unaware they have DVT as it can occur without noticeable symptoms. Those that do experience symptoms may experience pain or cramping in the leg, usually starting at the calf, warmth in the affected area, swelling in the leg, skin discoloration, etc.

Venous thrombosis tends to occur in areas with decreased or mechanically altered blood flow. Oxygen tension declines as blood flow slow with an increase in hematocrit. The hypercoagulable microenvironment that ensues down-regulates certain antithrombotic proteins including thrombomodulin and endothelial protein C receptor (EPCR).

In addition, hypoxia drives the expression of certain procoagulants including P-selectin. As the ratio of procoagulants to anticoagulants increases, so does the risk of thrombus formation.

DVT and COVID-19 Related Blood Clots can be caused by anything that prevents your blood from circulating including reduced mobility, contraceptives, medications, hormonal therapy, obesity, smoking, genetic disorders, etc.

It may be a surprise to some however, a common lifestyle factor that is associated with thrombosis is none other than physical inactivity.

Long hours of continuous sitting can lead to thrombus formation in the legs. Blood tends to pool in the muscular beds of the calf when your legs are still and hanging down for a long period.

Clots can also form within an artery. According to a study published in Radiology in 2020 COVID-19 is associated with life-threatening blood clots in the arteries of the legs. According to researchers, COVID-19 patients with symptoms of inadequate blood supply to the lower extremities tend to have larger clots than uninfected people with the same condition. During the peak of the pandemic in New York City, an increase in patients testing positive for lower extremity arterial thrombosis was observed.

In March and April 2020, 16 COVID-19-positive patients for symptoms of leg ischemia were identified. It’s been said that COVID-19’s association with lower extremity arterial thrombosis is likely related to a combination of factors including an increased tendency of the blood to clot, damage to the lining of the arteries, and immune reactions tied to the SARS-CoV-2 virus and COVID-19 infection.

Anticoagulants have been suggested for use in COVID-19 to mitigate the risk of venous and arterial thromboembolism.

Strict preventive measures such as exercise training, prophylactic drug use, and education about thrombosis risk in people staying at home through the mass media should be considered to prevent immobility-related DVT during the COVID-19 quarantine. Simple lifestyle modifications can also help to reduce the risk.

Some simple tips to keep your blood flowing include ankle pumps, leg extension, and seated march, etc. During these times don’t stop your child from playing the games and yourself from watching your favourite Netflix series continuously. Just be aware, enjoy it, and don’t forget to take a break and continue to Stay-At-Home.

Large-scale studies exploring thrombosis in the context of COVID-19 are awaited as this could be an area of intense study in the future.

References

Blum, E., Abdelwahed, Y. S., Spiess, E., Mueller-Werdan, U., Leistner, D. M., & Rosada, A. (2021). COVID-19# StayAtHome Restrictions and Deep Vein Thrombosis: Case Report. Interactive Journal of Medical Research, 10(1), e23443.
Healy, B., Levin, E., Perrin, K., Weatherall, M., & Beasley, R. (2010). Prolonged work-and computer-related seated immobility and risk of venous thromboembolism. Journal of the Royal Society of Medicine, 103(11), 447-454.
Khan, I. H., Savarimuthu, S., Leung, M. S. T., & Harky, A. (2020). The need to manage the risk of thromboembolism in COVID-19 patients. Journal of vascular surgery.
Karaali, E., Çiloğlu, O., Demirtürk, O. S., Keklikçioğlu, B., Akçay, İ., & Ekiz, T. (2021). Increased deep vein thrombosis cases during the COVID-19 quarantine. Phlebology, 36(2), 114-118.
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020i: S0049-3848(20)30120-1.
Radiological Society of North America. (2020, July 16). Dangerous blood clots form in leg arteries of COVID-19 patients. ScienceDaily.