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UK Researchers Identify COVID-19 Blood Clotting Cause

By Elizabeth Chapin

https://uknow.uky.edu/research/uk-researchers-identify-covid-19-blood-clotting-cause

LEXINGTON, Ky. (Sept. 17, 2020) — A new University of Kentucky College of Medicine study may provide answers for why so many COVID-19 patients experience thrombosis, or the formation of blood clots that obstruct blood flow through the circulatory system.

The research led by Jeremy Wood, Zach Porterfield and Jamie Sturgill in the Department of Internal Medicine; Beth Garvy in Microbiology, Immunology & Molecular Genetics; and Wally Whiteheart in Molecular & Cellular Biochemistry, suggests that localized inflammation in the lungs caused by COVID-19 may be responsible for the increased presence of blood clots in patients. The study also provides evidence suggesting the risk of thrombosis could persist after the infection clears.

The study examined the blood of 30 COVID-19 patients including 15 who were inpatients in the intensive care unit, and 15 who received care as outpatients at UK’s Infectious Diseases Clinic, along with eight disease-free volunteers who acted as a control group.

Compared to baseline, the COVID-19 patients had elevated levels of tissue factor, a protein found in blood that initiates the clotting process. Patients also had reduced levels of protein S, an anticoagulant that helps prevent blood clotting.

The researchers concluded that lung inflammation caused by COVID-19 is what leads to a decrease in protein S. This inflammation also causes immune and possible endothelial cell activation, which leads to increased tissue factor protein.

“What we’ve learned is that the clotting is not caused by anything systemic. Localized inflammation in the lungs is what’s driving this whole process,” Wood said. “With an increase in tissue factor and a deficiency in protein S, COVID-19 patients get more blood clotting without the ability to shut it down or control it.”

The study additionally showed that protein S levels remained low in some patients even after they tested negative for COVID-19, which suggests that blood clotting issues may persist after infection and long-term monitoring of thrombotic risk may be necessary.

Wood says this preliminary data could be a cause for concern. Certain viruses like HIV are linked to a long-term deficiency in protein S, which causes an ongoing risk of thrombosis in patients. It is not yet known if COVID-19 could cause a similar persisting protein S deficiency.

“Tissue factor and protein S are good markers to monitor for long-term thrombosis risk and the data suggest that we need to be monitoring these patients because we’re not seeing these parameters corrected immediately,” Wood said.

The research team recently received a grant from UK’s Center for Clinical and Translational Science (CCTS) to begin a longitudinal study to look at these levels in patients over the next year.

“This will help answer the question: will this risk remain like it is in the HIV patients or will it go away?”

The study was funded in part by an Alliance Grant through the College of Medicine as well as UK’s COVID-19 Unified Research Experts (CURE) Alliance through the Vice President for Research and the College of Medicine and the CCTS. It was a product of collaboration between a number of different groups at UK that have been studying COVID-19.

Additional collaborators include Martha Sim, Meenakshi Banerjee and Hammodah Alfar in the Department of Molecular and Cellular Biochemistry; Melissa Hollifield and Jerry Woodward with Microbiology, Immunology and Molecular Genetics; Xian Li with the Saha Cardiovascular Research Center; Alice Thornton with the Division of Infectious Disease; and Gail Sievert, Marietta Barton-Baxter and Kenneth Campbell with CCTS.

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On the same topic: As vaccines are coming on stream it is said most work by modifying or connecting to an S protein on the virus also, I think called the Spike protein. What are the implications for those of us with a Protein S deficiency?

Are we protected, or more likely to develop problems if infected with Covid 19?  Would we be able to have a vaccine or not? Would our medication, Rivaroxaban in my case, conflict with the Vaccine? Or is the whole thing unrelated and of no concern? These are things our local GP will almost certainly no know.

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You are right, news reports about the Coronavirus often refer to Protein S but they are talking about a Protein Spike, when describing the virus itself. This has nothing to do with the Protein S that circulates in our blood. Anticoagulants are sometimes used in the treatment of Covid.

The research shown above suggests that Protein S levels may be reduced by Covid, perhaps contributing to the possibility of clot formation. However that research was not conducted with a Protein S Deficiency in mind, and just as you could argue it might make the deficiency worse, it could also mean that we are more tolerant of an additional reduction. But you also need to bear in mind the scenario for that situation is when there is lung damage, in severe cases of Covid, probably at the induced ventilation stage.

It is highly unlikely that a vaccine would cause such a response. I am not a doctor and would not expect us to be treated any differently for vaccination, except that a thrombosis history might put those people nearer to the front of the queue. And taking anticoagulants probably reduces our risks of Covid complications. So overall, we are probably better placed than the average person.

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I was originally diagnosed with a portal vein thrombosis around the same time I lost my sense of smell for over a year. (This was about 6 years ago at age 49.) The olfactory loss was brought on by a viral infection (viral anosmia). I now wonder whether I had a type of coronavirus that affected my protein-s levels. I was diagnosed with borderline protein-s deficiency after the clot in my portal vein showed up. After I came off the warfarin for it, I had a subsequent DVT and am now on thinners for life. None of this kind of thing ever ran in my family and I've always been in good health generally, not overweight and active.

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Thrombosis can cause depletion of Protein S. In the case of Covid-19 the virus causes inflammation of the lungs, and subsequent damage causes clotting. The virus itself doesn’t cause the clots directly. To be reliable the screening for your diagnosis should have been based on blood samples taken a couple of months after your thrombosis, when your natural levels would have recovered.

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To get the vaccine or not?  I'm afraid getting COVID with PSD would be worse than the average person would experience, but I also am terrified of an injection that sends messages to my already confused blood messaging system.  Please share your experience or knowledge on how those of us with PSD should move forward.  I understand it is dangerous to hand out medical advice, but all of us with PSD know how hard it is to find anyone who has studied PSD and we lean on fellow sufferers for their experience.

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It is your choice whether you get the vaccine. The vaccine produces an immune response. Some people refer to the headaches, arm ache, temperature, tiredness, etc, that some people experience as side effects but in reality this is what you want... it means your body has noticed the (inactive) virus and is responding to it.

If you look at the statistics for the number of positive cases detected through testing (see Worldometer) the US has confirmed 34 million cases in a population of 332 million. So roughly 1 in 10 people have been infected. Of these 614,000 did not survive. That works out as a 1.8% fatality rate. That doesn’t include those with long covid symptoms.

If you choose not to be vaccinated, are you comfortable with a 1 in 55 chance of death?

 …bearing in mind there are 5 million active cases among fellow citizens that could lead to an infection (1 in 66 currently have a covid infection).

The alternative is to get the vaccine. It is approximately 94% effective. That improves your odds to 1 in 5,170. So it's not perfect, some people will not make it either way.

The 1 in 500,000 possibility of a rare side effect from the vaccine itself only tweaks that number by 0.01 - making it 1 in 5,170.01

Put that into context of a small town with say 20,000 population. With vaccine 4 deaths. Without vaccine 363 deaths.

Another benefit of the vaccine, apart from improving your odds of surviving the pandemic, is to reduce transmission. So your own vaccination helps to protect friends and family. It also reduces the numbers of patients in hospitals. If you become unwell the hospital can offer treatment. If it is full then more people could die due to lack of medical care. A full hospital reduces that 1 in 55 figure.

In my personal experience I had a strong immune response to the first dose of Astra Zenica. I had a migraine (which I suffer from anyway), temperature for a day, and my arm ached for 2 weeks. When I had my second dose my arm ached slightly for a week. You have to ask yourself, if it is the same drug and the same person, then why didn’t it produce the same ‘side effects’ ... of course the answer is my body had developed my immune defence and was ready second time around. It means it’s ready to deal with the actual virus if I come into contact with it.

From our Facebook Group with 1600 members some people have shared concerns about the combination of PSD with vaccines and with Covid. Nobody has reported any clotting issues as a result of the vaccine. Some people have reported they contracted Covid and recovered.

None of the vaccine makers have listed PSD as a contradindication but a few other health conditions may apply so you will need to ask your doctor for your personal circumstances.

Nobody is claiming that the vaccine makes you safe, only safer.

How you choose to balance the choice of getting, or not getting, the vaccine is up to you.

 

(As per the footer… Disclaimer: For your own health and safety you should always seek the advice of a qualified medical practitioner and not act on information published on this web site. No responsibility can be accepted for the content or absence of content published on this site for any reason.)

 

 

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