Mysterious blood clots are Covid-19’s last fatal surprise


A medical team returns a patient with Covid-19 to an intensive care unit in Stamford, Connecticut, United States.

A medical team returns a patient with Covid-19 to an intensive care unit in Stamford, Connecticut, United States.

WASHINGTON: After spending almost three weeks in an intensive care unit being treated for Covid-19, Broadway and the doctors for television actor Nick Cordero were forced to amputate his right leg.

The 41-year-old’s blood circulation had been hindered by a clot: another dangerous complication of the disease, which appeared in front-line reports from China, Europe and the United States.

While the so-called “thrombotic events” occur for a variety of reasons in intensive care patients, the rates among Covid-19 patients are much higher than one would otherwise expect.

“I was 40 years old in my intensive care unit with clots in my fingers that seem to be losing the finger, but there is no other reason to lose the finger than the virus”, Shari Brosnahan, doctor of intensive care at NYU Langone told AFP.

One of these patients suffers from a lack of blood circulation in the feet and hands, and she anticipates that an amputation might be necessary, or that the blood vessels could be so damaged that one extremity could fall from itself. even.

Blood clots are not only dangerous to our limbs, but can travel to the lungs, heart or brain, where they can cause life-threatening pulmonary embolism, heart attacks and strokes.

A recent article in the Netherlands in the journal Thrombosis Research found that 31% of the 184 patients suffered from thrombotic complications, a figure the researchers described as “remarkably high” – although extreme consequences like amputation are rare.

– Why is it happening? –

Behnood Bikdeli, a doctor at New York – Presbyterian Hospital, has assembled an international consortium of experts to study the issue. Their results were published in the Journal of The American College of Cardiology.

Experts have found the risks to be so great that Covid-19 patients “may need to take blood thinners, both preventively and prophylactically,” even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons are not fully understood, but he offered several possible explanations.

People with severe forms of Covid-19 often have underlying medical conditions such as heart or lung disease – themselves linked to higher clotting rates.

Then intensive care makes a person more likely to develop a clot because they stay still for so long. This is why, for example, people are encouraged to stretch and travel on long-haul flights.

It is also now clear that COVID-19 is associated with an abnormal immune response called a “cytokine storm” – and some research has indicated that this is also linked to higher clotting rates.

There could also be something in the virus itself that causes clotting, which has precedent in other viral diseases.

An article in The Lancet last week showed that the virus can infect the inner cell layer of organs and blood vessels, called the endothelium. This, in theory, could interfere with the coagulation process.

– Microclots –

According to Brosnahan, although diluents like heparin work for some patients, they don’t work for all patients because the clots are sometimes too small.

“There are too many microclots,” she said. “We don’t know exactly where they are. “

Autopsies have shown that the lungs of some people are filled with hundreds of micro clots.

However, the arrival of a new mystery solves a slightly older mystery.

Cecilia Mirant-Borde, an intensive care doctor at a military veterans’ hospital in Manhattan, told AFP that the lungs filled with microclimate help explain why ventilators work poorly for patients with low blood oxygen levels .

Earlier in the pandemic, doctors treated these patients according to protocols developed for acute respiratory distress syndrome, sometimes called “wet lung”.

But in some cases, “it’s not because the lungs are occupied with water” – it’s rather that the microcoagulation blocks the circulation and that the blood leaves the lungs with less oxygen than it does should.

It has been just under five months since the virus first appeared in Wuhan, China, and researchers are learning more about its impact every day.

“Although we react surprised, we shouldn’t be as surprised as we are. Viruses tend to do strange things, ”said Brosnahan.

While the dizzying array of complications can seem daunting, “it is possible that there are one or two unifying mechanisms that describe how this damage occurs,” she said.

“It is possible that it is the same thing and that there is the same solution. “


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