Rutgers Doctors: COVID Can Trigger Recurrent Blood Clots in Arms

NEW BRUNSWICK, NJ —Researchers at Rutgers Robert Wood Johnson Medical School are reporting the first instance of COVID-19 triggering a rare recurrence of potentially serious blood clots in people’s arms.

The case involved one man, age 85, and he also had a prior diagnosis of upper extremity (upper arm) blood clots, according to Rutgers.

The finding is important because, while there have been numerous reports of coronavirus causing deep vein thrombosis (blood clots) in the lower legs, this is the first study in which COVID-19 caused blood clots in the upper arm, said the Rutgers team.

“This is of concern since in 30 percent of these patients, the blood clot can travel to the lung and be possibly fatal,” said Dr. Payal Parikh, an assistant professor of medicine at Rutgers Robert Wood Johnson Medical School, who helped lead the study. “Other disabling complications include persistent swelling, pain and arm fatigue.”

This case was discovered when Rutgers studied 1,000 patients hospitalized COVID-19, all of whom who were admitted and discharged between March and May 2020.

The 85-year-old man led an active lifestyle, say researchers, and he played tennis weekly. In fact, he did not even know he had COVID until his left arm started swelling.

“The patient presented to his primary care physician with complaints of swelling in his left arm and was sent to the hospital for further management, where he was diagnosed with an upper arm blood clot and an asymptomatic COVID-19 infection,” said Dr. Parikh. “While his oxygen levels were not diminished, he was hospitalized for the management of the upper extremity deep vein blood clot. Often, blood clots are preceded by chronic inflammatory conditions exacerbated by immobility, and rarely do they occur in patients who are otherwise healthy and active at baseline.”

Most cases of deep vein thrombosis occur in the legs. Only about 10 percent of blood clots occur in the arms and of those cases only 9 percent recur.

The man had previously been diagnosed with deep vein thrombosis, at the age of 81. He also had long-standing hypertension, hypercholesterolemia, type 2 diabetes and coronary artery disease. He also had a pacemaker.

He smoked tobacco for 15 years, quitting at age 29, and said at the time that, until his cardiac symptoms worsened — before last spring — he had an active lifestyle of bicycling and playing tennis weekly.

The Rutgers team theorized that coronavirus caused inflammation and triggered recurrence of blood clots in his left upper arm — even though he had no other typical symptoms of COVID, such as labored breathing.

The study suggests that clinicians should consider testing for deep vein thrombosis and COVID-19 in patients who present with complaints of unexplained swelling.

Rutgers published their discovery in the journal Viruses. They say it can lead to better understanding of inflammation caused by COVID-19, and how COVID can lead to upper extremity blood clots and how best to treat them.

It is already known that coronavirus can cause blood clots and hyper, whole-body inflammation. In fact, one New York study found that hospitalized patients with COVID had much higher deep vein thrombosis rates (31 percent) than in hospitalized patients without COVID (19 percent).

People who test positive for COVID-19 should seek medical attention if they have declining oxygen levels, shortness of breath and any unexplained swelling.

“If you have been previously diagnosed with deep vein thrombosis or have chronic medical illness that predisposes you to blood clots, you have a higher risk for recurrence of a deep vein thrombus in the setting of a COVID-19 infection and thus, should be vigilant,” said Parikh.

Other Rutgers authors included Yesha H. Parekh, Nicole J. Altomare and Erin McDonnell.

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