WEDNESDAY, May 6, 2020 — As more evidence emerges that COVID-19 is tied to an increased risk of dangerous blood clots, new research suggests that giving patients blood thinners may improve their odds of survival.
“Using anticoagulants should be considered when patients get admitted to the ER and have tested positive for COVID-19, to possibly improve outcomes,” study senior author Dr. Valentin Fuster, physician-in-chief at the Mount Sinai Hospital in New York City, said in a hospital news release.
His team found that the big risk with the use of blood thinners — bleeding — was low in the group of patients studied. “However, each case should be evaluated on an individualized basis to account for potential bleeding risk,” Fuster stressed.
Over the past few weeks, physicians caring for patients hospitalized with COVID-19 have raised alarm bells after younger patients developed life-threatening clots and stroke. Recent research by the Icahn School of Medicine at Mount Sinai found that a large number of hospitalized COVID-19 patients have high levels of potentially life-threatening blood clots.
Doctors at New York City’s Mount Sinai Health System also reported a series of five such cases in an article published April 28 in the New England Journal of Medicine.
Patients ranged in age from 33 to 49 years of age — very young to be hit by stroke.
Two other large medical systems, Thomas Jefferson University Hospitals in Philadelphia and NYU Langone Health in New York City, also are reporting COVID-related strokes, according to the Washington Post.
Clotting associated with COVID-19 is so pronounced that “some people are beginning to say, ‘Look, anybody that comes to the hospital needs to be put on'” blood thinners at the start of their treatment, said Dr. Carlos del Rio, a professor of infectious diseases at Emory University in Atlanta.
Would such interventions help? To find out, Fuster’s group studied outcomes for nearly 2,800 COVID-19 patients admitted to five hospitals in the Mount Sinai Health System in New York City.
Of those patients, 28% received a full-treatment dose of blood thinners, an amount usually given to people who have or are suspected to have blood clots.
Blood thinner therapy was associated with improved survival among COVID-19 patients both in and out of intensive care, the study authors said.
Among patients placed on ventilators, nearly 63% of those who weren’t treated with blood thinners died, compared with 29% of those who were given the drugs, the researchers reported. Among patients on ventilators who died, those who didn’t receive blood thinners died after nine days, while those given the drugs died after 21 days.
Of all the patients who died, those on anticoagulants died after spending an average of 21 days in the hospital, while those who didn’t receive anticoagulants died after an average of 14 days in the hospital.
Importantly, there was no significant difference in bleeding events among patients who received or didn’t receive blood thinners, according to the study published May 6 in the Journal of the American College of Cardiology.
“This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism [clot in the lungs],” Fuster said.
Two physicians unconnected to the new study agreed that blood thinners might be warranted in many COVID-19 patients.
Already, New York City’s “Lenox Hill Hospital has been using anticoagulation on COVID-admitted patients at high risk for thrombosis [clots],” said Dr. Varinder Singh, who directs cardiology at Lenox Hill.
“This study is the first to confirm the benefits of anticoagulation during the acute illness,” Singh said, and “larger trials are needed to confirm the conclusion and best anticoagulation strategy.”
Dr. Mitchell Weinberg directs cardiology at Staten Island University Hospital, also in New York City. He said that given the mounting evidence that COVID-19 promotes clots, “there are concerns that we are not treating these patients with blood thinners aggressively enough or early enough.”
But the routine use of blood thinners in these patients is still “controversial,” Weinberg stressed.
“There is clearly so much to learn about thrombosis in patients with COVID. We have only begun to scratch the surface,” Weinberg said.
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Posted: May 2020