One of the many ways in which covid-19 wreaks havoc on the human body is by helping to cause abnormal blood clotting.

A new study supported by the National Institutes of Health (NIH) suggests that SARS-CoV-2, the coronavirus that causes covid-19, seems to release mysterious antibodies that mistakenly attack the body’s own cells to cause clots.

“That study showed a new mechanism where covid could be causing problems,” said Frank Sciurba, a professor of medicine and education who directs the University of Pittsburgh’s Pulmonary Function Exercise Physiology Laboratory.

“They found that half of the patients admitted to the hospital with covid have these antibodies,” Sciurba said. “In the process of attacking the virus, they somehow were creating these auto-antibodies that are directed against the lipids or the fats on the cell surfaces and activate the platelets which then drive them to be more prone to form these clots.”

NIH has selected Pitt to lead a trio of Phase 3 clinical trials involving covid-19 patients. The trials will explore the use of blood thinners in saving lives and improving care, especially among adult covid-19 patients at risk of developing life-threatening blood clots.

Matthew D. Neal, the Roberta G. Simmons Associate Professor of Surgery at Pitt who is involved in the trials, said that many patients who have died from covid-19 formed blood clots throughout their bodies, including in their smallest blood vessels. The unusual clotting causes multiple health complications from lung and other organ damage to heart attacks and strokes.

”This does appear to be unique to covid,” said Neal. “Although blood clots can be common among people with other types of infections or even other viral illnesses when they’re very sick, the frequency of these complications in covid is substantially higher. It really appears to be a substantial part of how the virus attacks the body and makes people sick.”

Neal emphasized that the decision made months ago to target the blood clotting system and the use of blood thinning medication is turning out to have increased relevance in the way covid is treated.

The clinical trials are designed to focus on three groups of patients assigned to either a low or high dose of the anticoagulant heparin. The groups include patients newly diagnosed with covid-19 with the idea of treating them as early as possible to potentially prevent blood clotting complications and/or progression of the disease from happening.

A second group includes patients already admitted to the hospital in order to understand whether using blood thinners when they are hospitalized decreases the overall severity of the illness. Does it shorten their time in the hospital? Does it decrease complications associated with covid? Does it decrease death or the risk of death?

“The final part of all this is that patients that have had covid and recover still seem to be at a higher risk of developing later blood clotting complications,” said Neal. “So, the question for the third trial is: After somebody recovers, and is well enough to be discharged from the hospital, is continuing them on a blood thinning medication associated with a decreased risk of these late blood clotting complications that we’ve seen?”

Neal said the in-patient part of the trials has gone well with its “captive audience” of patients. The outpatient group has been a little harder to round up and is not enrolling at the same rate as the in-patient trial group. The post-discharge trial has not officially launched but Neal anticipates it getting underway in the next couple of weeks.

“We’re hopeful that that trial will enroll rapidly with patients who have been part of the trials while they were in the hospital,” said Neal. “Once a patient has gone through their in-patient hospitalization they will have the option to participate a second time. The same patient could help us to understand whether or not extending the blood thinner for a longer duration of time prevents a longer term complication.”

Sciurba said it won’t be long before the trials yield information that can be used for treating covid-19 patients.

“If this in-patient trial goes as well as it seems to be going right now, it could be a matter of a month or two before we’ll have information, hopefully relatively quickly. With the outpatient pre-hospitalization trial, it may not be until the spring when we get some answers,” said Sciurba.

For his part, Neal said doing the study and having people participate in it is a critical piece to solving the covid-19 puzzle.

“The key message is the importance of these clinical trials to understanding how we treat the disease,” Neal said. “There is a lot of international optimism about the Pfizer and Moderna vaccines. I think what people need to realize is that the only reason we have the ability to have that optimism is because thousands and thousands of people agreed to participate in a trial.

“The same is true for these treatment trials. We want to have that same degree of enthusiasm about knowing how to treat people if they become sick as we do about our ability to vaccinate and prevent the disease as a whole.”

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