How does COVID-19 affect blood clotting (coagulation)?

Dr. Greg Piazza, NATF's Education Chair and Associate Professor of Medicine at Harvard Medical School is here to answer patients' most frequently asked questions about COVID-19 and clots.
*Last reviewed on September 15, 2020*

[jeffkrebs]

I was in ICU with covid-19, Pretty severe Pneumonia and 2 small blood clots on my lungs' PE. I'm on blood thinners and will be seeing a PE expert for followup in June. 1st 2 weeks, I had to plan my trip to the bathroom and find rest areas. 1 month later, I've increased my walking, now at 7.5km. Not easy, I take rests on hills but feel improvement every day

[abram]

(Clotting)
The endothelium is covered in ACE2. The virus directly infects squamous endothelial cells inactivating the ACE2 receptor. So there is no receptor to convert Angiotensin II to Angiotensin (1-7).
Angiotensin (1-7) is thus lowered. Ang (1-7) has been shown to have anti-oxidant and anti-inflammatory effects. Ang (1-7) plays protective roles in cardiomyocytes of spontaneously hypertensive rat by increasing the expression of endothelial and neuronal nitric oxide synthase enzymes leading to augmented production of nitric oxide. Ultimately, Ang (1-7) evokes anti-arrhythmogenic effects in animal models. In blood vessels, Ang (1-7) induces the release of vasodilators such as prostanoids and nitric oxide.
Angiotensin II is increased, thus increasing blood pressure by causing constriction (narrowing) of the blood vessels. Ang2 increases the sensation of thirst, the desire for salt, encourages the release of other hormones that are involved in fluid retention. Ang2 stimulates production of the hormone aldosterone, resulting in the body retaining sodium and losing potassium from the kidneys. Ang2 increases sodium retention and alters the way the kidneys filter blood. This increases water reabsorption in the kidney to increase blood volume and blood pressure. Ang2 causes inflammation response and damage to endothelial cells in the blood vesicles.
This damage causes the release of von Willebrand factor, triggering clotting factor VIII, that triggers clotting factors X to Xa. This clotting cascade causes the rapid formation of clots.
(Zinc + Chloroquine)
Zinc ions in the cells stop viral replication using RDRP, however ions don't go into cells without being gated in, so a zinc ionophore is needed. That is what Chloroquine is. Chloroquine given without zinc will starve the immune system of zinc, and why it is used for auto immune conditions, but when given early with zinc, will lower viral load. Later the virus forms protective replication/transcription complexes(RTC) using nsp3, 4, 6, protecting itself from RDRP attacks(chloroquine + zinc or remdesivir).  Prior to RTC formation, nsp1 binds to ribosomes blocking transcription of host RNA, preventing an interferon response.  After RTC's are formed nsp1 down regulates increasing viral replication, and before the host cell dies, but alerts the immune system.  At this point a high viral load is used to target T-cells as the virus also binds to CD147, letting it infect CD4+ and CD8+ cells, as well as red blood cells.  The virus should be able to bind to the 1-beta chain of hemoglobin.  This would dislodge iron ions and leave the virus bound to porphyrin, and be a cause of hypoxia.  If the red blood cell burst that would show as hyperferritinemia, but could also allow porphyrin bound virus to enter different cell types, not presenting ACE2 or CD147.  
Is there a spike in blood iron?

[Farahbody]

Plz i have antithrombin 3 deficinecy and protien c deficiency .. high fibrinogen level .. mthfr mutation .. what if i get covid infection???

[BrianPremo]

I have long covid, due to symptoms I was in the ER and my d-dimer was 1.186. They ruled out pulmonary embolism via heart ct scan and chest X-ray, but other than that offerer no real answers. I’m freaked out.

[Abdurrahman-bmhd]

My brother in law aged 35yrs, with uncontrolled diabetes, he is corona positive, initially fever was there for 3 days, but now only cough is there, no Shortness of breath, Should he take Aspirin as prophylaxis?

[ebufi]

Can adding Corticoids to treatment prevent clots or/and DIC? Would Heparin and Fresh Plasma help in DIC?

[falcoreluckdragon]

I have 2 blood clots in my leg. I'm on blood thinners taking eloquis . symptoms for 90 days. Started blood thinners 4 days ago active 36 year old male does anyone know my chances of recovering? 0 corona virus symptoms

[whitneyesparza]

How does having Factor 5 Leiden affect a person that gets Covid 19

[debbemccall]

This was all in medical-ese and not in patient language. For those of us on OACs, are we at higher risk if we are infected with COVID-19? Yes or no.