Mysterious blood coagulation complication kills coronavirus patients

Craig Coopersmith woke up as early as usual in the morning of the day and typed his daily questions into his phone. “Good morning, Team Covid,” he wrote, asking for updates from ICU team leaders who work at 10 Emory University Health System hospitals in Atlanta.

One doctor said one of his patients had a strange blood problem. Despite taking the anticoagulant, the patient was still developing a blood clot. The second said he saw something similar. And one third. Immediately everyone in text chat reported the same.

“It was then that we knew we had a big problem,” said paramedic Cooper Smith. When I checked with the staff at other medical centers, I was even more wary that “20, 30, or 40% of the patients had been reached.”

A month ago, when the country was blocked in preparation for the first wave of the coronavirus, many doctors were convinced they knew what they were dealing with. Based on earlier reports, the novel coronavirus appeared to be the standard respiratory virus, despite being an infectious, deadly virus that has not been vaccinated or treated. They’ve seen how covid-19, the disease that the new coronavirus causes, attacks not only the lungs Kidney, heart, intestine, liver, brain.

Doctors are increasingly reporting bizarre and disturbing cases that appear to fail to follow any of the textbooks they trained. They describe patients with surprisingly low oxygen levels-usually unconscious or dying-speaking or swiping on the phone. An asymptomatic pregnant woman suddenly falls into cardiac arrest. Patients who appear to have a mild illness that will worsen within minutes of all traditional methods and die at home.

Since there is no clear pattern for age or chronic condition, some scientists assume that at least some of these abnormalities may be explained by serious changes in the patient’s blood.

Concerns are very serious and some groups of doctors have raised controversial potential for using covid-19 to give prophylactic anticoagulants to everyone.

A thrombus that turns a red liquid into a gel appears to be the opposite of the uncontrolled bleeding that occurs with Ebola, dengue, Lassa, and other hemorrhagic fever. However, they are actually part of the same phenomenon and can have catastrophic consequences as well.

Autopsy Shows the lungs of some people filled with hundreds of microclots. Large-sized abnormal blood clots can be destroyed and reach the brain or heart, causing stroke or heart attack. On Saturday, Broadway actor Nick Cordero, 41, was infected with the novel coronavirus and had his right leg amputated with a blood clot that prevented blood from reaching his toes.

Lewis Kaplan, a doctor at the University of Pennsylvania and director of the Critical Care Medical Society, said that doctors treat people with coagulation complications every year, from patients with cancer to victims of severe trauma, It doesn’t solidify. “

“The problem we have is that we know we have blood clots, but we don’t yet know why they have blood clots,” Kaplan said. “We don’t know, so we’re scared.”

“It creeped on us”

The first sign that something went wrong was in the foot, which was blue and swollen. Even patients using ICU’s anticoagulants had thrombosis. This is not uncommon in one unit of one or two patients, but it occurs in so many patients at the same time. Next comes the clogging of the dialysis machine, which filters impurities in the blood when the kidneys are dysfunctional and clogged several times a day.

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

After that, an autopsy came. When he opened the lungs of a deceased patient, he expected to find evidence of damage to the small air sacs that exchange oxygen and carbon dioxide between pneumonia and the bloodstream. Instead, they found small blood clots everywhere.

Video conferences were held at some of the nation’s largest medical centers. tough. Yale New Haven. University of Pennsylvania. Brigham and Women’s. Colombian Presbyterian. The theory was shared. The cure was discussed.

Although the biological views on why this is happening and what can be done about it have been inconsistent, many believe that blood clots make up a significant portion of U.S. deaths from covid-19. I came to believe. At home.

In retrospect, there was a hint that the blood problem was also a problem in China and Italy, but it was much of a footnote on the call for information sharing that focused on research and destruction of lung diseases.

“It creeped on us. There weren’t many international stories about this.

Helen Boucher, an infectious disease specialist at the Tufts Medical Center, said there was no reason to think there was any difference in the US virus. More likely, she said, the problem was more apparent to American physicians because the unique demographics of American patients make heart disease more vulnerable to the destruction of blood clots. And most of obesity. She also noted that the key differences facilitating detection of blood clots in the monitoring and treatment of patients in the ICU in this country are small.

“Part of this is due to the fact that we have such an incredible intensive care unit,” she said.

Leading cause of death

The body’s cardiovascular system is often described as a one-way network that connects the heart to other organs. Blood is a transport system that transfers nutrients to cells and removes waste products from the cells. Colds and finger cuts can lead to changes that can help repair the injury, but when the body receives more trauma, the blood can overreact and can cause excessive blood clots or bleeding. It can lead to equilibrium.

Scientists call this a “hemostasis disorder.” In mathematics, a confusion is a permutation where elements are not in their original position.

Harlan Krumholz, a cardiologist at the Yale New Haven Hospital Center, told who the blood complications were the result of a direct attack on the blood vessels or the patient’s immune system’s overactive inflammatory response to the virus. I don’t know.

“One theory is that when the body becomes very engaged in the fight against the invaders, the body begins to consume clotting factors, which can cause blood clots or bleeding,” he said. “With Ebola, the balance was more towards bleeding. With covid-19, there are more blood clots.”

Dutch study published April 10 in journal Study of thrombosis Providing more evidence that the problem was widespread, it was found that 38% of 184 covid-19 patients in the intensive care unit had abnormally coagulated blood. Many patients are still hospitalized and at risk for additional complications, so the researchers called it a “conservative estimate.”

Initial data for China In a sample of 183 patients, we found that over 70% of patients who died of covid-19 had small blood clots throughout their bloodstream.

Although acute respiratory distress syndrome still appears to be the leading cause of death in covid-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year researcher at the Columbia University Irving Medical Center. , Thrombus Journal of American Heart Association.

“I guess it’s one of the top three causes of death and deterioration in covid-19 patients,” he said.

That awareness has prompted many hospitals to change the way they think about illness and manage it. When the new coronavirus first hit, such as the Centers for Disease Control and Prevention, put people with asthma at the top of the list of most vulnerable people. But the European researchers in Lancet say that the underestimation of asthma patients was “impressive.” Earlier this month, asthma was not among them when New York released data on the top chronic health problems of those who died at covid-19. Instead, they were almost all cardiovascular diseases.

Some medical centers have begun to administer small doses of anticoagulant to hospitalized covid-19 patients as a preventive measure, and many medical centers are adjusting the dose upwards for the most serious illnesses . The challenge is that the more you give, the more you lose the balance in the opposite direction and the more likely your patient is to bleed.

Another big mystery that doctors want blood problems to reveal is why obstetric patients collapse during or after childbirth.

Published papers American Journal of Obstetrics & Gynecology MFM In late March, we elaborated on how two women without previous symptoms of covid-19 received intensive care. The first was a 38-year-old patient from the New York Presbyterian / Columbia University Irving Medical Center in Manhattan who presented with a fever of 101.3 during delivery of a C-section and began profuse bleeding. The second woman (33) also underwent a C incision, but the next day she had a cough and dyspnea. Her heart beating irregularly and her blood pressure jumped as high as 200/90.

Some doctors and researchers said covid-19, the relationship between coagulation and pregnant women, is an “area of ​​interest.” Women in childbirth may experience coagulation and bleeding complications due to the involvement of a blood-rich placenta, but some women’s bodies are “imbalanced” by covid-19. May cause additional cases.

“There’s a lot of speculation,” Krumholtz said. “It’s one of the frustrating things about this virus. We’re still in the dark.”

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