Space travel is full of unknowns—like how to treat a blood clot in outer space.
When a NASA astronaut aboard the International Space Station discovered a deep vein thrombosis (DVT) in their neck, the agency called on Stephan Moll for help.
A blood clot expert at the UNC School of Medicine and long-time NASA enthusiast, Moll’s first reaction was to ask if he could visit the ISS to examine the patient himself.
“NASA told me they couldn’t get me up to space quickly enough,” he said, a tinge of sadness in his statement. “So I proceeded with the evaluation and treatment process from here in Chapel Hill.”
The unidentified astronaut on an unidentified mission (kept anonymous for privacy reasons) was two months into a six-month assignment when the clot emerged.
The asymptomatic DVT showed no warning signs; it was spotted only after the rocketeer had taken ultrasounds of their neck for research on how body fluid is redistributed in zero gravity.
An ISS first, there was no established method of treatment for a blood clot in zero gravity.
Enter Moll.
A member of the UNC Blood Research Center, he was called upon for his “vast” knowledge and treatment experience of thrombus on Earth.
UNC School of Medicine professor Stephan Moll at NASA (via UNC School of Medicine)
The normal protocol for treating a patient with DVT involves a three-month regimen of blood thinners to prevent the clot from growing—but which can also cause internal bleeding.
“In either case, emergency medical attention could be needed,” Moll said. “Knowing there are no emergency rooms in space, we had to weigh our options very carefully.”
Doctors settled on blood thinners, of which the ISS keeps only a limited supply: The astronaut began a course of treatment with an injectable drug while awaiting a new shipment of pills to the floating lab.
Throughout the cosmic therapy (which lasted more than 90 days), the astronaut performed ultrasounds on their own neck, with guidance from a radiology team on Earth. Moll also spoke with the space traveller via email and phone.
“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,” he explained. “And amazingly the call connection was better than when I call my family in Germany.”
Four days before returning home to Earth, the astronaut ended their pill program at the behest of NASA’s medical team, worried about the physical demands and potential dangers of re-entry.
The cosmonaut landed safely on Earth and the blood clot required no further treatment, according to a paper co-authored by Moll and published in the New England Journal of Medicine.
If not for that body fluid study, however, there is no telling what could have happened. Which is why Moll continues to work with NASA to learn how blood and blood clots behave in outer space.
“Is this something that is more common in space?” Moll implored. “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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