In a preprint article not yet peer-reviewed, a South Africa-based study suggests disease pathways in acute COVID-19 infection may be effective targets for Long COVID treatment. The test treatment entails combining several existing drugs aimed mostly at combating excessive microclotting in the blood. Learn what they discovered.*

A unique approach to Long COVID treatment

A team of researchers from South Africa’s Stellenbosch University argue that Long COVID stems from endothelialitis, or damage to/inflammation of the endothelium (a thin cell layer lining the inside of blood vessels) brought on by COVID-19. Additionally, research has shown that Long COVID patients have widespread blood clotting and platelet buildup. If these issues aren’t addressed during initial infection, the researchers say, they can persist and give rise to Long COVID symptoms.

To address clotting issues during severe COVID infection, they maintain that a single-drug approach would be ineffective. Instead, they believe a multi-pronged treatment approach is needed to return clotting activity to safe, healthy levels. Real-time monitoring of microclot and platelet activity would be required to avoid risk of excessive bleeding. The researchers argue that this approach would also be effective, and the real-time monitoring necessary for treating Long COVID.

What the researchers did

To test their theory regarding a multi-drug approach to resolving excessive microclotting in Long COVID, the researchers recruited 91 South African participants experiencing Long COVID symptoms.

• The dual-platelet therapy was composed of 75 mg clopidogrel + 75 mg aspirin once a day, with a direct oral anticoagulant of 5 mg apixaban twice a day.
• Treatment ranged from two to six months or longer, depending on individual case severity.
• Blood samples were taken before and after treatment, with microclot presence and platelet activity assessed.
• Samples were also analyzed after two weeks of treatment to ensure that patients weren’t at risk of bleeding.
• Long COVID symptoms were reported before and after treatment.

Most participants had no major pre-existing conditions.

What they found

Though a previous study found that apixaban alone was not effective for Long COVID patients, this new study found that combination therapy was able to help relieve patients’ symptoms.

• Prior to treatment, most participants reported Long COVID symptoms of:
  • Fatigue
  • Brain fog
  • Breathlessness
  • Muscle and joint pain
• After treatment, most participants saw their symptoms resolve.
• Lab analysis showed decreased microclotting and platelet activity.

There were no serious bleeding events reported.

What it means

The researchers concluded that fibrin amyloid (aggregated protein) microclots, platelet overactivity, and widespread endothelialitis prevent oxygen transport at a capillary/cellular level and lead to Long COVID symptoms. By reducing excess clotting and inflammation, they wrote, “triple anticoagulant therapy represents a promising treatment option that appears to be highly efficacious and warrants controlled clinical studies.”

*Laubscher, G. J., Khan, M. A., Venter, C. (2023, March 21). Treatment of Long COVID symptoms with triple anticoagulant therapy. Research Square. https://www.researchsquare.com/article/rs-2697680/v1