To prevent the formation of pulmonary embolisms or blood clots in the bodies of Covid-19 patients, PGIMER is administering blood thinning medicine as a prophylactic and even a therapeutic drug to those who are at risk of developing such clots in their body.
This medicine can help increase survival rates of coronavirus patients.
“This medicine is administered to a lot of bedridden patients in hospitals in general as well, but with Covid- 19, we have found higher levels of d dimer in the blood of patients than usual,” says Dr Pankaj Malhotra from the Department of Internal Medicine. D dimer is a protein fragment which indicates the presence of thrombosis or blood clot formation in the body. According to an editorial in the Lancet, increased levels of D Dimer in the body was associated with high risk of mortality in Covid-19 patients in studies conducted by a Chinese hospital.
Globally, especially in the US, UK and Italy, several deceased COVID-19 patients have been observed with complications in vital organs where blockages in the arteries have been formed due to blood clots in the body. A pulmonary embolism, which is a blockage of an artery in the lungs, is a common occurrence observed in patients with severe respiratory discomfort and infection. However, these blood clots have also been observed in kidneys and brains of patients in Italy.
“At PGIMER, we are giving low molecular heparin in small dosages as a prophylactic to those who are at lower risk. In patients where D dimer levels are higher, we are giving therapeutic low molecular heparin until the patients are hospitalised or until the levels of D dimer in their body remain high,” says Dr Malhotra. Low molecular heparin is a blood thinning drug or an anticoagulant used most commonly for clinical treatment of deep venous thrombosis or clotting, especially in patients who are bedridden for longer periods of time pre and post orthopedic procedure or surgeries.
“It is not a drug specifically used for Covid-19 only, it has been used in hospitals always, especially for patients who are critical and admitted in the ICU,” says Dr HK Bali, head of cardiac sciences at Paras Hospital in Panchkula. Dr Bali explains however, that in Covid-19 cases, patients have seen to have developed blood clots due to the infection itself. “There are many atypical conditions including higher d dimer levels, as well as some cardiac conditions in patients who do not have a history of such co-morbidities observed in Covid-19 patients,” says Dr Bali.
Though traditional risk factors such as co-morbidities, critical illness and old age have been linked to the formation of thrombosis in the past, what is worrying about Covid-9 is that younger patients with no such risk factor have also developed blood clots. In the US, young asymptomatic patients have died of strokes while self isolating in their homes. Autopsies of such patients revealed the presence of clots in their brains.
Another healthcare worker treating Covid-19 patients at PGIMER’s Nehru extension block says that though the research and data on the connection between thrombosis and Covid- 19 is still quite limited, the hospital is taking proactive steps to ensure such complications do not arise. “Even the ICMR is yet to develop a set guideline on this because of all the uncertainty, but we are doing out best to ensure people go back home safe and sound from here,” adds the healthcare worker.
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