Blood Clots, Stroke, And COVID-19

Premier Health Now May 6, 2020

Women grasping the side of her head, while lying on the couch, and checking her temperature

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Doctors are sounding the alarm about a possible link between blood clots and stroke in some COVID-19 patients. The cause for concern? Some of these patients are younger than 60 without the typical respiratory symptoms of COVID-19 — or common stroke risk factors.

To learn more, we talked with Esteban Cheng-Ching, MD, a vascular neurologist and neurointerventionalist with Premier Health’s stroke team.

“We are not completely certain about what causes clots in COVID-19 patients,” says Dr. Cheng-Ching. “It’s not clear if it’s the virus itself or inflammation related to the body’s hyper-immune response to the virus.”

A stroke occurs when a clot blocks a blood vessel leading to the brain. The lack of blood flow and oxygen can damage brain tissue and lead to issues with movement and speech. Blood clots can form anywhere in the body. If they break off and travel to the lungs or the brain, serious symptoms can result.

Clots Appear Throughout the Body

Early reports form Wuhan, China, noted increased clotting in COVID-19 patients that led to deep vein thrombosis and pulmonary embolisms. China also reported clotting in patients undergoing kidney dialysis. Reports from the Netherlands cited COVID-19 ICU patients with increased blood clots in the legs and lungs, as well.

Many COVID-19 patients also show increased levels of D-dimer, says Dr. Cheng-Ching. This protein fragment appears when a clot dissolves in the body. Higher levels of D-dimer signal the body is forming or trying to break down lots of clots.

Other reports link mini blood clots to discolored toes and fingers.

“Again, the direct relationship is not yet known,” says Dr. Cheng-Ching. “We learn something new every day with this virus”.

A Worrisome Stroke Trend

Doctors in New York and Philadelphia say they have seen an unusually large number of people in their 30s and 40s with the deadliest type of stroke, called an LVO (large vessel occlusion) stroke. In a span of three weeks, 40 percent of LVO hospital admissions at 15 medical centers were in COVID-19 patients under age 50.

“That is rare in young people,” says Dr. Cheng-Ching. “But they all had COVID testing, so they knew it was related.”

He says such strokes usually occur in people older than 65 with heart disease, diabetes, hypertension, high cholesterol, or atrial fibrillation.

Another study of 214 COVID-19 patients treated at three hospitals in Wuhan found one third had neurological complications. Among that group, 6 percent experienced a stroke, says Dr. Cheng-Ching.

Some doctors now suggest screening all COVID-19 patients for stroke.

The number of major strokes among young people also is on the rise at Premier Health. Dr. Cheng-Ching says the health system typically treats between six and eight LVOs a month. He shared these figures:

January: Seven LVOs in patients all older than 60
February: Nine LVOs with four patients younger than 60.
March: 15 LVOs with five patients younger than 60.
April: Final data not yet available, but there were at least three LVOs under age 60

“All of these patients showed up without the typical COVID-19 symptoms, so they were not tested,” Dr. Cheng-Ching says. “But the trend is concerning.”

Protect Yourself From Clots And Stroke

The economic, emotional, and social effects of COVID-19 can impact your health. As Ohio continues to live under a stay-at-home order, you can take steps to reduce risk factors for blood clots and stroke, says Dr. Cheng-Ching. He suggests:

Be active. Sitting or lying down for long periods of time can lead to clots, especially in the legs. Walk around your house or yard or follow a virtual exercise class. Being inactive also has been associated with increased stroke risk.
Eat healthy. Eat snacks and meals that are as healthy as you can make them. Think plenty of fruits and vegetables and lean meats.
Manage stress and anxiety. Being isolated at home or working from and helping your child with online learning can lead to stress and high blood pressure. Both conditions increase your risk for stroke and heart attack. Try breathing exercises or yoga to calm yourself.

Seek Care For Mild Stroke Symptoms

While strokes among COVID-19 patients may be on the rise, fewer people are going to emergency rooms with minor stroke symptoms. This phenomenon could have dangerous consequences, says Dr. Cheng-Ching

“We don’t think people are not having them, we think they are not coming to the hospital or dismissing the mild stroke symptoms,” says Dr. Cheng-Ching. Numbness in the arm or face or minor slurring of words can be signs of a stroke. Small or minor strokes can be a warning sign that a larger, potentially more damaging stroke is on the way.

“If you have stroke symptoms, no matter how mild, you should go to the hospital,” Dr. Cheng-Ching says. “We can treat a mild stroke and prevent a bigger one.” He adds that hospitals have processes in place to ensure safety for all patients and are always ready to treat patients with symptoms of stroke.

Know the Signs Of Stroke

May is National Stroke Awareness month. Learn to recognize stroke symptoms and warnings signs. An easy way to remember what to look for is to think and BE FAST:

B — Balance: Does the person have a sudden loss of balance?
E — Eyes: Has vision been lost in one or both eyes? Is there double vision?
F — Face: Ask the person to smile. Does one side of the face droop?
A — Arm: Ask the person to raise both arms. Does one arm drift downward?
S — Speech: Ask the person to say something. Is the speech slurred or garbled?
T — Time: If you notice any of these symptoms, call 911 immediately.