How on Earth does someone treat a life-threatening blood clot when you’re in space? Dr Stephan Moll at the University of North Carolina School of Medicine — a doctor and clotting expert — can tell you how.

In an unprecedented case, an astronaut on a six-month mission at the International space station developed a deep vein thrombosis (DVT) in the jugular vein, two months into their mission. There were no symptoms to detect the clot, which was thrown up during a routine ultrasound of all the astronauts’ necks in a study of how body fluid is redistributed in zero gravity.

 Astronaut with blood clot on ISS gets successfully treated by doctor on Earth

A 3D model of the International Space Station (ISS). Image Courtesy: NASA

Returning to Earth was not an option, because space travel is expensive and not to be taken lightly, NASA contacted Dr Moll to treat the astronaut.

Not wanting to miss the chance to go to space, Moll asked if NASA could send him off to the space station for the astronaut’s treatment. NASA responded in the negative. Sworn under the Hippocratic oath and with an astronaut’s life hanging in the balance, Moll went ahead with the diagnosis and treatment from right here on Earth.

“NASA told me they couldn’t get me up to space quickly enough, so I proceeded with the evaluation and treatment process from here in Chapel Hill,” said Moll.

Normally, doctors would refer to previous cases to check the prognosis but this was an unprecedented case and Moll had no diagnostics or samples to turn to — they had to set a precedent. Moll and a team of NASA doctors decided to treat the astronaut with blood thinners, which everyone agreed was the best course of treatment.

“Normally the protocol for treating a patient with DVT would be to start them on blood thinners for at least three months to prevent the clot from getting bigger and to lessen the harm it could cause if it moved to a different part of the body such as the lungs,” Moll said. “There is some risk when taking blood thinners — if an injury occurs, it could cause internal bleeding that is difficult to stop…emergency medical attention could be needed…We had to weigh our options very carefully.”

Not only does the ISS not have an emergency room, it also has a limited supply of blood thinners which astronauts will have to make do with till the next resupply planned mission. The astronaut patient (whose details haven’t been made public by NASA to maintain the astronaut’s privacy) injected him/herself for 40 days till they ran out. On the 43rd day, a resupply mission delivered the required medicines to the space station.

During their treatment, the astronaut called Dr Moll on his home landline and converse via emails to update with the progress.

“When the astronaut called my home phone, my wife answered and then passed the phone to me with the comment, ‘Stephan, a phone call for you from space.’ That was pretty amazing,” said Moll. (Who wouldn’t think so? Imagine getting a call from space. I can’t relate but Brad Pitt surely can).

Dr Stephan Moll helped diagnosis and treat an astronaut with a blood in their neck, in space. Image credit: University of North Carolina

Dr Stephan Moll helped diagnosis and treat an astronaut with blood in their neck, in space. Image credit: University of North Carolina

According to a press statement, four days before the astronaut was to return home (to Earth), they stopped taking the pill. The team of doctors decided that space travel is dangerous enough and physically demanding, they didn’t want to take a chance. If the astronaut was somehow injured during their re-entry, the wound could worsen significantly because of blood thinners, making it a risky treatment to a riskier illness.

The astronaut landed safely on Earth and the blood clot didn’t require any further treatment.

Moll co-authored a study on this case and the findings have been published in The New England Journal of Medicine. He continues to work along with NASA to answer questions like “Is this something that is more common in space? How do you minimize risk for DVT? Should there be more medications for it kept on the ISS?”

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