How a blood clots test has reduced numbers in intensive care

Edwin Van BeekEdwin Van Beek
Edwin Van Beek | Freelance
A leading radiologist has highlighted how a ground- breaking report in Holland that linked fatal blood clots to Covid-19 intensive care patients resulted in treatment that saw a 50 per cent increase in positive discharges.

Edwin Van Beek, an honorary consultant radiologist at NHS Lothian, says that hospitals in Rotterdam reduced the number of people in intensive care units by almost half after introducing a D-dimer test for detecting blood clots.

A positive D-dimer result can indicate that there may be significant blood clot (thrombus) formation and breakdown in the patient’s body. This test was shown to have predictive value in Covid-19 patients in China as to who was going to recover or who was more likely to succumb to the disease.

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Therefore this test can be used to make decisions on patients receiving blood thinners and who require additional radiology investigations to search for blood clots. Blood thinners can both prevent and treat these blood clots,

Some patients will develop early onset of blood vessel disease with thrombosis starting in small vessels, but which can affect larger vessels as well. Added with the existing risk for thrombosis due to the immobilisation that comes with lying in intensive care beds this can lead to the development of venous thrombosis – which results in pulmonary embolism that in turn leads to the acute deterioration of patients. This can affect blood clots entering into the lungs, but also other organs like the brain (stroke) and kidneys (kidney failure) may be affected.

Van Beek said: “Basically we started using the D-dimer test a few weeks ago. The report came out in the Netherlands on the 9 April and became public on the 16th April. A study in the Lancet that came from China showed that this test had prognostic significance – so people with the highest values had the least likelihood of surviving. Those with low levels were surviving and that fits with the whole thrombosis process.”

Dr Tracey Gillies, medical director, NHS Lothian, said: “Our clinical teams carefully follow the guidance as it develops from UK expert groups and we update our care plans accordingly.

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“As a result, our clinical teams are very aware of the emerging pattern of disease in patients with Covid-19 and that some of them are more susceptible to developing blood clots as part of the disease.

“Therefore we had already altered our usual treatment protocols to reflect this.”

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