29/04/2021 Astronaut receives treatment for blood clot during ISS mission

SPACE

Astronaut receives treatment for blood clot during

ISS mission
By David Szondy
January 02, 2020

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Stephan Moll, shown here at NASA, had to perform some long-distance telemedicine for an astronaut aboard the
ISS UNC School of Medicine

The International Space Station (ISS) almost got an old-fashioned house call after one of the astronauts
was diagnosed with a deep vein thrombosis (DVT) in the jugular vein of their neck. The potentially life-
threatening blood clot was treated remotely with the help of University of North Carolina Health Care
clot expert Dr. Stephan Moll over a three-month period using medicines already aboard the space
station.

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29/04/2021 Astronaut receives treatment for blood clot during ISS mission
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Since the earliest days of manned space ight, keeping space crews healthy has been a major concern.
Astronaut candidates undergo a thorough selection process and everything possible is done to make
sure that they are t for ight. Even then, missions have been fraught with crews suffering from space
sickness, u, diarrhea, and other ailments.

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Until now, astronaut maladies have been relatively mild, which is good because the nearest emergency
room to the ISS is 250 miles and several hours away at the end of a very stressful spacecraft ride. But that
changed when an ISS astronaut was performing an ultrasound on their neck as part of a research study
to learn more about how body uid is redistributed in the human body in zero gravity.

For privacy reasons, the name of the astronaut and other details have been withheld, though they were
two months into a six-month mission.

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29/04/2021 Astronaut receives treatment for blood clot during ISS mission

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Though the astronaut showed no other symptoms, the scan clearly showed the presence of a blood clot
in the jugular vein. Such clots can be extremely dangerous because they can dislodge and move into
more vital spots like the lungs, cardiac blood vessels, or the brain. Therefore, treatment is literally vital.
The problem is that space medicine is still, in many ways, still in its infancy and there aren't any
established procedures for treating DVT in zero gravity.

"My rst reaction when NASA reached out to me was to ask if I could visit the International Space Station
(ISS) to examine the patient myself," says Moll. "NASA told me they couldn't get me up to space quickly
enough, so I proceeded with the evaluation and treatment process from here [at the UNC Blood
Research Center at Chapel Hill, North Carolina]."

"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 added. "There is some risk when taking
blood thinners that if an injury occurs, it could cause internal bleeding that is dif cult to stop. In either
case, emergency medical attention could be needed. Knowing there are no emergency rooms in space,
we had to weigh our options very carefully."

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29/04/2021 Astronaut receives treatment for blood clot during ISS mission

The International Space Station (Photo: NASA)

If Moll couldn't make a house call, it also wasn't possible to send the preferred blood thinners to the
space station, so Moll and a team of NASA doctors were restricted to prescribing the medicines already
aboard the ISS, which included a limited supply of the blood thinner Enoxaparin.

Since no more medicine would be available until the next supply mission, Moll prescribed dosages to be
administered by subdermal injections over 40 days. Three days after stocks of the blood thinner ran out,
a shipment of Apixaban, which is in pill form, arrived by spacecraft, allowing the treatment to extend to a
total of over 90 days. During this time, the astronaut conducted more ultrasound scans while Moll
consulted by email and phone calls.

"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," says Moll. "It was
incredible to get a call from an astronaut in space. They just wanted to talk to me as if they were one of
my other patients. And amazingly the call connection was better than when I call my family in Germany,
even though the ISS zips around Earth at 17,000 miles per hour."

Though the treatment seemed to be working, there was still a bit of suspense because the return to
Earth involves being exposed to some heavy g-forces and other stresses, so the medical team stopped
the doses of Apixaban four days before the astronaut entered the Soyuz capsule. On the day, the

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astronaut landed safely and made a full recovery, but the lack of symptoms to indicate there was a clot is
still of concern to Moll and the NASA medical team.

"Is this something that is more common in space?" asked Moll. "How do you minimize risk for DVT?
Should there be more medications for it kept on the ISS? All of these questions need answering,
especially with the plan that astronauts will embark on longer missions to the Moon and Mars."

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Moll discusses the treatment in the following video.

UNC Expert Helps NASA

UNC Expert Helps NASA

Source: University of North Carolina Health Care

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David Szondy
David Szondy is a freelance journalist, playwright, and general scribbler based in Seattle, Washington. A retired eld
archaeologist and university lecturer, he has a background in the history of science, technology, and medicine with a
particular emphasis on aerospace, military, and cybernetic subjects. In addition, he is the author of a number of
websites, four award-winning plays, a novel that has thankfully vanished from history, reviews, scholarly works ranging
from industrial archaeology to law, and has worked as a feature writer for several international magazines. He has been
a New Atlas contributor since 2011.

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