An assessment for risk of an occlusion in a blood vessel in COVID-19

1. Use of medication that inhibits the coagulation of the blood

If you use any of the medicines that are listed below which inhibit the coagulation of the blood, you are protected against the risk of an occlusion that a coronavirus infection causes.

• So called blood thinners (Marevan, Eliquis, Xarelto, Lixiana, Pradaxa)
• Heparin that is injected under the skin (Fragmin, Innohep, Inhixa, Ghemaxan, Enoxaparin Becat)

If you do not use any of the above-mentioned medicines that inhibit the coagulation of blood, you may be at risk of developing an occlusion in connection with a coronavirus infection. Begin by checking your symptoms and then the risk factors.

2. Symptoms 

Are any of the criteria that are listed below met in your case:

• fever > 37,5°C
• a severe cough
• shortness of breath

If you have a mild infection, medication that prevents occlusions is not needed.

If you have severe symptoms, continue to 2.1 and continue doing the assessment.

2.1 Risk factors

Do you have at least one of the risk factors that are listed below (significant risk of an occlusion):

•  Previous occlusion in a vein or artery
•  Tendency to develop occlusions (such as: APC resistance, factor V Leiden gene defect, prothrombin gene defect G20210A, antithrombin deficiency, protein C or protein S deficiency, essential thrombocytosis, polycythemia vera, myeloma, PNH disease, antiphospholipid-antibody syndrome)   
•  An active cancer or malign blood disease
•  Multiple injuries or a recent spinal cord injury
•  A big operation less than one month before and/or current bed rest because of the operation
• Pregnancy
• Childbirth or a cesarean section less than six weeks before

OR

Do you have at least three of the risk factors that are listed below:

• Age at least 60 years
• Body mass index (BMI) over 30. Link: BMI calculator
• Uses a wheelchair or is paralyzed
• A heart or vascular disease (with the exception of a hypertension that is well under control)
• Venous insufficiency in a leg
• Diabetes
• Fatty liver
• An autoimmune disease (e.g. Crohn’s disease, ulcerative colitis, a connective tissue disease, rheumatoid arthritis)
• A severe kidney disease
• A recent operation (within six weeks), a fracture in an arm or a leg or a closed plaster on a leg 
• Replacement therapy with oestrogen (orally, not a gel or a band-aid) or a combined oral contraceptive (with the exception of a contraceptive that only contains progesteron i.e. minipill)
• The psychopharmaceutic drug klozapin (Leponex, Froidir, Clozapine Accord)
• Smoking.

OR

If you are ≥ 60 years old AND are mainly in bed rest for over three days.

3.  Instructions – what should I do?

If you have any of the symptoms described in point 2 (see above) and you have at least one of the risk factors listed in the first group (significant risk of an occlusion) or you have at least three risk factors listed in the second group or you are ≥ 60 years old and are mainly in bed rest for over three days, contact your health care clinic:

However, please note that the questions that are asked here are used for screening and you do not necessarily need medication to prevent occlusions even if you have risk factors.

During a coronavirus infection, the risk of an occlusion can be reduced by:

• Drinking enough (usually 2,5 litres per day)
• Changing one’s position often enough
• Even if you are bedridden, trying to stand up and walking regularly, changing your position, moving your legs and avoiding sleeping pills
• Moving around indoors as much as your health allows
• Using compression socks when resting in bed, if these are available and you have used them before to prevent occlusions.
• Making sure to take the blood pressure, diabetes and cholesterol medication that you have been prescribed in accordance with the instructions. Measure your blood pressure and blood glucose levels if you have monitors at home.
• Stopping smoking.
• Practising good oral and dental hygiene.

Contact the health care services immediately if you have symptoms of a an occlusion, such as pain in a leg or an arm or in the chest or shortness of breath, a headache that gets worse, symptoms on just the other side of the body or pain in the abdomen.

Those who belong to a risk group should contact healthcare professionals more readily than others. Risk group includes

• Persons aged 60 and older
• Persons who have:
  • a severe heart disease
  • a poorly controlled pulmonary disease
  • diabetes with related organ damage
  • a chronic liver or kidney insufficiency
  • a disease that weakens the immune system such as cancer being actively treated with cytostatic
  • medication that severely weakens the immune system (such as cortisone treatment in large doses)
  • pregnant persons.

If a medicine that prevents occlusions is prescribed because of COVID-19, the patient must pay for the medicine.