HAEMATOLOGY
Blood clot prevention in COVID patients
Bernard Ross explains how the company’s Geko device has been providing life threatening blood clot prevention for hospitalised patients with COVID-19 and discusses the emerging data and clinical opinion that now suggests COVID-19 is an endothelial disease.
The number of clotting problems related to COVID-19 is unprecedented and many months in, from the first reported case in China, UK ICU clinicians and leading epidemiologists are coming to the conclusion that COVID-19 isn’t just a respiratory illness, but, instead, something that can ultimately evolve into a vascular illness that affects the endothelium.
Initial data
As early as January, studies from China confirmed what many ICU teams across the UK and globally were fast seeing, that hospitalised patients with COVID-19 were presenting with a high blood clot risk and a high bleed risk – an incidence rate of over 60% in immobile critically ill COVID-19 patients. Collectively, the studies called for improved blood clot prevention strategies and stressed the importance of individual patient bleed risk assessment, prior to prescribing high-dose blood thinners, which can worsen bleed risk.
Treatment for bleed risk and clotting in COVID-19 patients With VTE established as a major contributor to COVID-19 multi-organ failure, anticoagulation is critical and drug prophylaxis is the primary intervention, especially for immobile ICU patients on ventilators. It is important to add that similar increases in thrombotic risk were seen with H1N1m influenza (Swine Flu), therefore the phenomenon is not new but not seen before on this scale.
COVID-19 patients, at high risk of VTE can have bleeding issues related to the virus or have an unacceptable bleed risk history. For these patients, drug prophylaxis can cause further bleeding. Clinicians therefore rely on mechanical compression prophylaxis, using either Intermittent Pneumatic Compression (IPC) or, more recently, the
OCTOBER 2020
Geko device to prevent VTE and minimise the risk of bleeding with, or without, drug prophylaxis.
The device is also clinically proven to produce physiologically normal shear stress on endothelial cells, increasing the production and the release of anti- thrombotic, pro-fibrinolytic, vasodilation agents to help prevent clots.
The solution represents an alternative to IPC prophylaxis. IPC devices enclose the leg in a plastic cuff filled with air from an electric pump. The cuff inflates and deflates in a repeating cycle moving blood through the veins towards the heart. The blood flow increase helps prevent the blood clot formation.
While IPC devices do not cause the same bleed complications as drug therapy, IPC is not suitable for all patients, due to fragile skin, a recent wound, leg ulcer or allergy to cuff materials. The electronic pump is also moved between patients, requiring decontamination – a potential source of virus transmission if not sterilised fully. Conversely, the daily disposable Geko device – the size of a wrist-watch and
discarded after patient use – is a single-use therapy that takes just 60 seconds to fit, ensuring less nurse-to-patient contact time, less exposure to viral load and no cross-contamination risk. Its small size also ensures greater compliance for patients with fragile skin or cardiovascular related contraindications. Recommended by NICE and cleared
by the FDA for blood clot prevention, Geko is applied non-invasively to the skin over the common peroneal nerve at the side of the knee. It gently stimulates the nerve, once every second, activating the calf and foot muscle pumps resulting in increased laminar blood flow in the deep veins of the calf, at rate equal to 60% of walking, exerting systemic protective shear stress on the endothelium in immobile, critically-ill COVID-19 patients, without a patient having to move. All other mechanical IPC devices increase blood flow only once every minute.
The device has been in use for over three years for blood clot prevention in immobile, high-risk acute stroke patients, with over 700,000 individual units sold. To date,
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