The link between COVID-19 disease and blood clots is well established. How should we use our knowledge of clotting in COVID-19 to improve patient care in future waves?

Be aware of the link between COVID-19 and thrombosis

There is a strong link between COVID-19 and thrombosis, particularly in those that are hospitalized or more severely affected: one in twenty hospitalized patients and one in six critical care patients with COVID-19 develop blood clots in the veins. Venous thromboembolism or VTE includes deep vein thrombosis or DVT in the legs and pulmonary embolism or PE in the lungs. Typical symptoms include leg pain and swelling in those with DVT and chest pain and breathlessness in those with PE. Patients and carers should be vigilant for these symptoms and seek medical attention as necessary. 

Hospitalized patients with COVID-19 require special measures to prevent thrombosis

Because VTE is so common it is important that all patients admitted to hospital receive preventive measures. This usually takes the form of injections of blood thinners called low molecular weight heparin. These should be started promptly after admission and, given at the right dose, will help prevent blood clots and help the patient get better. Current evidence does not support routinely giving blood thinners before admission to hospital or after discharge from hospital.

Use blood tests sensibly

Blood clotting markers are commonly raised in COVID-19 disease as part of the inflammation triggered by infection. Early studies showed high blood clotting markers were associated with the severity of the disease. A recent Irish study even showed higher levels of clotting markers in those who go on to develop long COVID-19 syndrome. In the first wave such blood clotting tests particularly D-dimer were used to guide treatment and were overused, both globally and in the Indian setting. There is no evidence for using D-dimers to direct use of preventive blood thinners in or outside of hospital and in the next wave such use should be discouraged.

Have the jab

Mass vaccination is the key to counter future waves. India is vaccinating over 10 million people daily, a huge achievement. This has to continue. COVID-19 vaccines, whether Covishield, Covaxin, Sputnik V and others, have provided the shield to protect against the COVID-19 virus, by enhancing the body’s immune system. In the future, boosters are also likely to be available after the first 2 doses have been given.

Vaccines for all

Nearly 65 per cent of India’s population live in the hinterland. Vaccination of this population is essential to curb future waves. Awareness policies to fight misinformation and vaccine hesitancy need to be put in place via mass media to ensure their inoculation. In addition, India has 15-17 crore children in the 12-18 age bracket and policy should be fast tracked to acquire medically approved vaccines are available in the market. This vulnerable age group will need to be inoculated to protect future outbreaks, just as is being currently practiced in many Western countries. 

Address healthcare infrastructure needs

Healthcare infrastructure, whether its oxygen production capacity, jumbo centers, or better patient care is key to tackling any future waves. Better management of COVID-19 patients by way of fluid management, respiratory support, use of steroids and more is crucial. Healthcare need to maintain a good stock of life-saving drugs and oxygen concentrators. The majority of infected individuals have mild disease and should be managed simply at home with the use of paracetamol for fever and headache as well as self-isolation measures. Continuing precautions such as social distancing, good hygiene and mask-wearing especially in enclosed spaces and public transport are also important to keep the virus at bay.