A study has associated COVID-19 with life-threatening blood clots in the arteries of the legs, otherwise known as lower extremity arterial thrombosis.
The findings revealed that COVID-19 patients that present with the condition are more likely to have limb amputation or in extremities, death.
The researchers noted that it is important that health care providers are aware of lower extremity arterial thrombosis as a possible complication of COVID-19 infection, as early diagnosis is usually crucial for limb preservation.
Findings from the study were published in Radiology, a monthly, peer reviewed, medical journal, owned by the Radiological Society of North America.
Speaking on the study, a Consultant Orthopaedic Surgeon, Dr. Saheed Babajide, said the condition may be caused by a blood clot in an artery, which can be very serious, as it can stop blood from reaching vital organs.
He explained that oxygenated blood is carried by the pulmonary vein and that oxygen flow is impeded from flowing to the lower extremities, which could make the area to become numb and die.
Dr. Babajide explained that arteries are blood vessels that carry blood from the heart to the rest of the body and to the heart muscle, adding that any obstruction in the path can lead to death or even amputation, especially when it comes to the lower extremities.
The former Chairman of Medical Guild, Lagos, said based on reports that emanated from post-mortem examinations carried out in China on COVID-19 patients, there was evidence of coagulopathy, a condition in which the blood’s ability to clot is impaired.
“This has made some pathologists to still wonder what could be damaging the vessels, and is causing such a reaction around the area, leading to what is known as thrombosis – blood clot.
“If that thrombus dislodges and attaches itself to the vessel, it will block a major pulmonary artery, causing pulmonary embolism. This is why some people can die suddenly.
“This clot can also block or obstruct blood flow in the affected area, as well as cause serious complications if the clot moves to a crucial part of the circulatory system, such as the brain or the lungs.
“That explains why some people will suddenly start to cough uncontrollably and become breathless, as the clot would have blocked flow of oxygen supply,” he explained.
According to the authors of the study, COVID-19 patients with symptoms of inadequate blood supply to the lower extremities tend to have larger clots and a significantly higher rate of amputation and death than those who are not infected with the same condition.
They pointed out that COVID-19 association with blood clots in the pulmonary arteries is well-established.
They, however, said that less is known about the virus’ connection to lower extremity arterial thrombosis, a condition characterized by blood clots in the arteries that impede the flow of oxygenated blood to the lower part of the body.
According to the study, during the peak of the COVID-19 pandemic in New York City, radiologists at the city’s Montefiore Medical Centre, observed an increase in patients testing positive for lower extremity arterial thrombosis on CT angiography exams.
The patients, they noted, arrived at hospitals with coldness, pain or discoloration of their legs.
“Frequently these symptoms of leg ischemia, a condition in which blood flow to the lower extremities is restricted, were accompanied by respiratory distress, cough, fever and altered mental status,” they added.
The alarming trend, the researcher further noted, prompted them to look more closely at a possible connection between COVID-19 and lower extremity arterial thrombosis and whether people with the virus had a worse prognosis.
In March and April 2020, 16 COVID-19-positive patients were identified by the researchers within an average age of 70, who underwent CT angiography of the lower extremities for symptoms of leg ischemia.
The patients were then, compared with 32 COVID-19-negative patients, within an average age of 71, who underwent CT angiography with similar symptoms in previous years and who were well matched with COVID-19 cohort for demographic and clinical characteristics.
“All patients with COVID-19 infection undergoing lower extremity CT angiography had at least one clot in the leg, compared with only 69% of controls.
“The clots in the COVID-19 patients were significantly larger and affected arteries higher up in the leg with greater frequency than those in controls.
“Death or limb amputation was more common in the COVID-19 patients,” the researchers observed.
According to the lead author and Assistant Professor at Albert Einstein College of Medicine, New York City, Inessa Goldman, “We found that arterial thrombosis associated with COVID-19 infection was characterized by dire outcomes, namely strikingly increased rates of amputation and death, which in our series were 25 per cent and 38 per cent, respectively.
“For comparison, the rate of both amputation and death was only three per cent among controls.
“It is unclear whether the patients’ concurrent COVID-19-related pneumonia, the virulence of the COVID-19-related clotting disorder or delayed initial arrival to the hospital contributed to these outcomes.”
Goldman further noted that COVID-19 patients presenting with symptoms of leg ischemia only were more likely to avoid amputation or death than patients who had symptoms of ischemia and systemic symptoms including cough, respiratory distress or failure, hypoxia, fever, or altered mental status.
“In our cohort, none of the five patients presenting with complaints pertaining to leg symptoms only, such as pain or discoloration, without systemic symptoms sustained amputation or died,” the radiologist said.
Goldman further noted that with infection rates rising in many parts of the country, it is important that physicians are mindful of the connection between COVID-19 and lower extremity arterial thrombosis.
“Awareness of lower extremity arterial thrombosis as a possible complication of COVID-19 infection is important for all providers who take care of these patients, because early diagnosis is usually crucial for limb preservation in lower extremity ischemia,” she added.
The radiologist concluded 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.
“This continues to be an area of intense study around the world.”
On the type of emergency medical intervention that could help salvage the situation from degenerating into amputation or death, Dr. Babajide said because oxygen supply to the body would have reduced, the first thing is to place the person on oxygen or ventilator for resuscitation.
He said the clot can be detected through an angiogram machine, which will show the location of the blockage.
“From there, the blood clot can be removed by a cardiologist. Medications can also be given to break down the blood clot, especially if it is a small on.
“That is why it is advisable to always readjust the elderly and sick people, so that they won’t be stationed in a particular position for too long.
“They are also given medications that won’t allow the blood to clot,” Dr. Saheed said.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
The post Blood clot from COVID-19 complications may cause amputation, death appeared first on Healthwise.