Alarmed by thickening of COVID patients, New York doctors try new treatments


NEW YORK: As the new coronavirus spread to New York in late March, doctors at Mount Sinai Hospital noticed something strange in the patients’ blood.
Signs of thickened blood and clotting have been detected in different organs by doctors of different specialties. This would turn out to be one of the alarming ways in which the virus is ravaging the body, as doctors there and elsewhere are beginning to realize.
At Mount Sinai, nephrologists noticed that the kidney dialysis catheters were blocked by clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see strangely bloodless portions of the lungs. Neurosurgeons have faced an increase in their usual number of strokes due to blood clots, the age of the victims being younger, with at least half of the tests positive for the virus.
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“It is very striking how much this disease causes clots to form,” said Dr. J Mocco, a neurosurgeon from Mount Sinai, in an interview, describing how some doctors think COVID-19, the disease caused by the coronavirus is more than a disease lung. In some cases, said Mocco, a stroke was the first symptom of a young COVID-19 patient.
As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients are now receiving high doses of an anticoagulant before signs of coagulation even appear.
“Maybe, just maybe, if you prevent clotting, you can make the disease less serious,” said Dr. David Reich, president of the hospital. The new protocol will not be used on some high-risk patients because blood thinners can cause bleeding in the brain and other organs.
In the three weeks starting in mid-March, Mocco saw 32 stroke patients with severe blood blockages in the brain, double the number usual for that period.
Five were unusually young, under the age of 49, with no obvious risk factors for stroke, “which is crazy,” he said. “Very, very atypical. The youngest was only 31 years old.
At least half of the 32 patients would be positive for COVID-19, said Mocco.
Meanwhile, Dr. Hooman Poor, a lung specialist on Mount Sinai, found himself working late with 14 patients on respirators. The fan readings were not what he expected.
The lungs did not appear rigid, as is common in pneumonia. Instead, it seemed like the blood was not flowing freely through the lungs to be ventilated with each breath.
Poor met with a kidney doctor that night, who noticed that dialysis catheters were often blocked by clots.
“And I said,” It’s funny that you mentioned this because I feel like all of these patients have blood clots in their lungs, “” Poor recalls.
Reich, the president of the hospital, spoke to Poor about Mocco’s upsurge in strokes and said the two doctors should team up, organizing days of discussions and meetings with department heads. hospital.
At 2:46 a.m. on Easter Sunday, Poor sent Mocco his first draft of what would become the new treatment protocol.
As their services began to overflow with COVID-19 patients, doctors at Mount Sinai read articles describing similar findings by doctors from China’s Hubei province and other hard-hit regions, and discussed them with their peers during phone calls and webinars.
Mocco called neurosurgeons he knows elsewhere in the country. At Thomas Jefferson University Hospital in Philadelphia, Dr. Pascal Jabbour had started to see a similar increase in stroke among people with COVID-19. Freezing the blood of his patients reminded him of congenital conditions such as lupus or certain cancers.
“I have never seen other viruses cause this,” said Jabbour.
In Boston, the Beth Israel Deaconess Medical Center started a clinical trial earlier this month to see if tPA, an anti-coagulant, could help seriously ill COVID-19 patients.
Clotting can develop in anyone who gets very sick and spends long periods of time on a ventilator, but doctors say the problem appears to manifest itself earlier in COVID-19 patients as a more direct result of the virus.
In Mount Sinai, intensive care patients often receive heparin, an anticoagulant, at lower prophylactic doses. Under the new protocol, higher doses of heparin normally used to dissolve clots will be given to patients before clots are detected.
The treatment joins a growing toolbox at the hospital, where some patients receive antibody-rich plasma from recovered COVID-19 patients or experimental antiviral drugs.
The American Society of Hematology, which has also noted coagulation, says in its advice to physicians that the benefits of anticoagulation therapy for COVID-19 patients who do not already show signs of coagulation are “currently unknown”.
“I would certainly not expect harps to play and angels to sing and people to tear off their IV lines and waltz out of the hospital,” said Reich. “It will probably be something where it will just moderate the extent of the disease. “


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