Abnormal clotting seen in severe COVID-19 patients

[Sushi]

Clinicians are reporting that some young patients are having strokes due to blood clots. Critical care doctors are beginning to give severe patients preventive anticoagulation therapy to prevent or help dissolve these clots. There are many articles on this but here is one:

Abnormal Clotting and COVID-19

Abnormal clotting, apparently resulting from endothelial damage, has been described in patients with severe COVID-19 disease, and Chinese clinicians recommend initiating prompt anticoagulation therapy in all severe COVID-19 patients.

 

[andyguitar]

Quite a bit to take in from reading the report but one thing that stood out for me was the possibility that the cardio symptoms are a result of lack of oxygen from the lung problems caused by covid and not directly by the virus.

 

[Sushi]

Quite a bit to take in from reading the report but one thing that stood out for me was the possibility that the cardio symptoms are a result of lack of oxygen from the lung problems caused by covid and not directly by the virus.

Yes, I have read more technical articles too as I am already on an anticoagulant because of Afib. What I read (from Mass General) is that they are switching patients who are already on an anticoagulant to low molecular weight heparin as its half life is very short and they can more fine-tune the anticoagulation.

The novel coronavirus appears to be causing sudden strokes in adults in their 30s and 40s who are not otherwise terribly ill, doctors reported Wednesday....There’s growing evidence that Covid-19 infection can cause the blood to clot unnaturally, and stroke would be an expected consequence of that....“Our report shows a seven-fold increase in incidence of sudden stroke in young patients during the past two weeks. Most of these patients have no past medical history and were at home with either mild symptoms (or in two cases, no symptoms) of Covid,” he added. [Dr. Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York]

https://www.cnn.com/us/live-news/us-coronavirus-update-04-22-20/index.html
That isn't a direct link as this article was one of a long list of updates.

 

[andyguitar]

Something that has started to come up is that patients appear to have only mild symptoms (able to sit up in bed and chat) but have very low oxygen levels which are not obvious from their demeanor. When tested oxygen level are at a critically low level. So maybe its a case of this being missed that is leading to the high incidence of stroke, not something unknown and sinister.

 

[Sushi]

Something that has started to come up is that patients appear to have only mild symptoms (able to sit up in bed and chat) but have very low oxygen levels which are not obvious from their demeanor. When tested oxygen level are at a critically low level. So maybe its a case of this being missed that is leading to the high incidence of stroke, not something unknown and sinister.

It has been suggested that anyone with symptoms get a pulse oximeter to check this.

 

[Sushi]

Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels, or a hyperactive inflammatory response to the virus by the patient’s immune system

....Autopsies

have shown some people’s lungs fill with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes....“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.” https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/

 

[Wishful]

When I first saw the thread, I thought it said "Abnormal clothing". That would be an interesting viral symptom.

 

[Sushi]

"Abnormal clothing".

 

[andyguitar]

 

[PatJ]

More info from this article on the Washington Post (I've bolded one section that was particularly unsettling to read):

Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a very contagious and lethal one with no vaccine and no treatment. But they’ve since become increasingly convinced that covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.

Many are also reporting bizarre, unsettling cases that don’t seem to follow the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.

With no clear patterns in terms of age or chronic conditions, some scientists now hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.
...

Autopsies have shown that some people’s lungs are filled with hundreds of microclots.
...

The first sign that something was going haywire was in legs, which were turning blue and swelling. Even patients on blood thinners in the ICU were developing clots in them — which is not unusual in one or two patients in one unit, but is for so many at the same time. Next came the clogging of the dialysis machines, which filter impurities in blood when kidneys are failing, and were getting jammed up several times a day.

“There was a universal understanding that this was different,” Coopersmith said.

Then came the autopsies. When they opened up some deceased patients’ lungs, they expected to find evidence of pneumonia and damage to the tiny air sacs that exchange oxygen and carbon dioxide between the lungs and the bloodstream. Instead, they found tiny clots all over.
...

And although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. coronavirus deaths — possibly helping to explain why so many people are dying at home.

 

[Wishful]

Sushi is absolutely right. Covid really does cause abnormal clothing.

 

[Tammy]

In a nutshell: A virus has the capability of damaging the endothelium (cells that line the interior surface of blood vessels). Damaged endothelium present an increased risk of blood clotting because the damage exposes underlying tissues such as collagen that trigger blood clotting reactions. Platelets adhere to collagen and from a temporary plug. I guess bacteria have the capability of doing the same. Never knew

 

[andyguitar]

In a nutshell: A virus has the capability of damaging the endothelium

Yes the flu virus can do this. So covid is not unique in causing this problem,

 

[PatJ]

This article on the Washington Post is interesting: Young and middle-aged people, barely sick with covid-19, are dying from strokes. Some didn’t even know they were infected.

Some extracts, with one section that I've bolded:

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.
...

The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.
...

“We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz said of the deadliest strokes. “We have never seen so many in their 50s, 40s and late 30s.”

Raz wondered whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by covid-19: “So they survive the lung side, and in time develop other issues.”
...

Oxley said the most important thing for people to understand is that large strokes are very treatable. Doctors are often able to reopen blocked blood vessels through techniques such as pulling out clots or inserting stents. But it has to be done quickly, ideally within six hours, but no longer than 24 hours: “The message we are trying to get out is if you have symptoms of stroke, you need to call the ambulance urgently.”

 

[andyguitar]

This article on the Washington Post is interesting: Young and middle-aged people, barely sick with covid-19, are dying from strokes. Some didn’t even know they were infected.

This indicates to me that people might not seem to very ill, or even ill at all, but are if fact seriously unwell. So problems with making an accurate diagnosis might be at the root of this.

 

[percyval577]

There has been the suggestion that a genetic predisposition plays a role in covid-19 disease, as e.g. in the UK and the US a lot of people of African origin are affected, also that in Italy and Spain the number of severely ill are high may point to this direction.

The suggestion then was that it might be Glucose-6-phosphate_dehydrogenase_deficiency, which helps to manage malaria, where the plasmodium enters the red blood cell.

I thought that this sounds reasonable, but the north of Italy and Spain might not be that much areas that favour any malaria adaptions, though still possible. Also China has such areas, more in the south. I think Wuhan has been said to be within this region.

 

[Marylib]

@percyval577 I think Wuhan is in Hubei Province. At any rate, they have the world's largest medical school in Wuhan. This is from a friend involved in science and whose family (originally from England) have ties to that area. The only person I know well from China is from the south - where they speak Cantonese. This is Guangdong Province, across the bay from Hong Kong. But in terms of the topic on blood clots, yeah, I am concerned about my niece near Portland, Oregon, who came down with pneumonia in early January, before anything about covid-19 came to light in the US. She's pregnant and due to deliver end of May.