COVID-19 and Thrombosis Risk: Insights from a Hematologist

Maria DeSancho, MD

In the second and final part of her interview with HCPLive®, Maria DeSancho, MD, of New York-Presbyterian / Weill Cornell Medical Center and American Thrombosis and Hemostasis Network (ATHN) collaborator, offered thoughts on the risk of thrombosis in patients with coronavirus disease 2019 (COVID-19).

She highlighted the need to better ascertain risk in both symptomatic and asymptomatic patients, as well as in non-hospitalized infected individuals. She drew particular attention to a study aimed at clarifying these essential questions surrounding risk level.

A retrospective study of 3 Chicago hospital systems previously reported a 7.5% prevalence of thrombotic events among hospitalized patients with COVID-19. 

DeSancho, whose practice is based in New York, discussed her experience working with the influx of patient cases, particularly at the outset of the pandemic, and compared it with current conditions.

You already mentioned that you see COVID patients in the hospital, and we know that COVID-19 is associated with thrombotic and hematological events. Can you just speak more to your experiences with these patients?

I live in New York, so we had the first wave—which was overwhelming. At the time, we didn't know anything about this infection. It came like an avalanche, basically. Patients were quickly intubated.

When someone is in the intensive care unit, then the risk of thrombosis is much higher, because they get lines. It's a common complication to a get line-associated thrombosis as well as deep vein thrombosis, since they're not moving. As a consequence, they may get pulmonary embolisms.

So, we were seeing a lot of thrombotic events initially. However, on the second, and maybe third or fourth, wave, we saw that the steroid dexamethasone that patients usually receive seemed to have blunted the inflammatory component that is part of the thrombotic mechanism. Therefore, the risk of getting thrombotic events seems to be less now, compared to what see saw in the beginning.

Another important aspect, in my opinion, is the patients who do not get hospitalized but still have COVID. One of the questions a clinical trial is trying to address is whether these patients should be on an anti-coagulant.

That study is double-blinded and has 4 arms. One of them is placebo, the other one is using aspirin, another is an anti-coagulant at the preventive dose, and another is an anti-coagulant at the therapeutic dose. It's an ongoing trial, but that will answer our question.

Any final thoughts or comments you want to offer?

I think the public should be aware of what to watch for. We're always trying to educate the patient, because I think ignorance causes a lot of trouble. If they are mindful, and if something is abnormal, they should seek prompt medical evaluation.

Many times, especially in social media, media outlets leave information that is deleterious for people. When information is placed in these social media channels, I think people have to be mindful of what is there and ensure it is accurate. Otherwise, that can fuel more fear.

Go here to read Part 1, "Janssen’s COVID-19 Vaccine Pause: Insights from a Hematologist."