Covid-19 : Bloodclots Not Pneumonia Killing Patients

[glockman]

Published
Apr 28, 2020, 7:04 am SGT
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WASHINGTON (AFP) - After he had spent nearly three weeks in an intensive care unit being treated for Covid-19, Broadway and TV actor Nick Cordero's doctors were forced to amputate his right leg.

The 41-year-old's blood flow had been impeded by a clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.

To be sure, so-called "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among Covid-19 patients are far higher than would be otherwise expected.

"I have had 40-year-olds in my ICU who have clots in their fingers that look like they'll lose the finger, but there's no other reason to lose the finger than the virus," Shari Brosnahan, a critical care doctor at NYU Langone told AFP.

One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicts an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.

Blood clots aren't just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.

A recent paper from the Netherlands in the journal Thrombosis Research found that 31 percent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" - even if extreme consequences like amputation are rare.

WHY IS IT HAPPENING?

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

The experts found the risks were so great that Covid-19 patients "may need to receive blood thinners, preventively, prophylactically," even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons aren't fully understood, but he offered several possible explanations.

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

Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That's why for example people are encouraged to stretch and move around on long haul flights.

It's also now clear the Covid-19 illness is associated with an abnormal immune reaction called "cytokine storm" - and some research has indicated this too is linked to higher rates of clotting.

There could also be something about the virus itself that is causing coagulation, which has some precedent in other viral illnesses.

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

MICROCLOTS

According to Brosnahan, while thinners like Heparin are effective in some patients, they don't work for all patients because the clots are at times too small.
"There are too many microclots," she said. "We're not sure exactly where they are."

Autopsies have in fact shown some people's lungs filled with hundreds of microclots.

The arrival of a new mystery however helps solve a slightly older one.

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

Earlier in the pandemic doctors were treating these patients according to protocols developed for acute respiratory distress syndrome, sometimes known as "wet lung".
But in some cases, "it's not because the lungs are occupied with water" - rather, it's that the microclotting is blocking circulation and blood is leaving the lungs with less oxygen than it should.

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

"While we react surprised, we shouldn't be as surprised as we were. Viruses tend to do weird things," said Brosnahan.

While the dizzying array of complications may seem daunting, "it's possible there'll be one or a couple of unifying mechanisms that describe how this damage happens," she said.

"It's possible it's all the same thing, and that there'll be the same solution."

https://www.straitstimes.com/world/...od-clots-are-covid-19s-latest-lethal-surprise

 

[Leongsam]

Don't worry too much about it because exactly the same thing happens with influenza. It has been found that H1N1 increases the risk or blood clots by a whopping 23 times!

The media is making it sound like it is something unique to Covic-19 but it is actually a common result of many ARDs

 

[Leongsam]

https://vascular.org/news-advocacy/jvs-report-swine-flu-and-respiratory-distress-linked-blood-clots

 

[Leongsam]

SVS: Frequent blood clots documented in swine flu patients with ARDS

EMPIRICAL SYSTEMIC ANTICOAGULATION IS ASSOCIATED WITH LESS VENOUS THROMBOEMBOLISM IN CRITICALLY ILL INFLUENZA A H1N1 ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS, Journal of Vascular Surgery: Venous and Lymphatic Disorders, May 2019.


CHICAGO, Illinois, May 2019 – A new study has found that ICU patients with swine flu and acute respiratory distress syndrome were 33 percent more likely to develop a blood clot if they were not given a blood thinner when admitted.


Since the virus showed up in humans 10 years ago, researchers have noticed the high incidence of mortality, morbidity and health care costs in patients with swine flu, also known as H1N1.


“To our knowledge, this is the first study to document venous thromboembolic events (VTE) incidence in adult ICU patients with severe acute respiratory distress syndrome (ARDS) due to H1N1 viral pneumonia,” noted Dr. Andrea Obi, first author of the report, published in May’s Journal of Vascular Surgery: Venous and Lymphatic Disorders.


‘This high rate of VTE was encountered despite empirical anticoagulation in more than half of our cohort,” she added.


The cohort study from the University of Michigan confirms that the high incidence of venous thromboembolic events (VTE) in patients with H1N1 ARDS (acute respiratory distress syndrome) can be mitigated with empiric anticoagulation upon admission.


The severity of swine flu is manifested by non-pulmonary complications, mainly VTE. In response to a clinical report from the University of Michigan in 2009, The Centers for Disease Control and Prevention issued a warning regarding the “development of a hypercoaguable state and fatal thromboembolic events” for patients with this disease.


The actual incidence of VTE in H1N1 infection is unknown, nor is the therapeutic effect of anticoagulation in this ill patient population.


University of Michigan researchers led by Dr. Lena Napolitano, in a follow up to their 2009 report, performed a single-center retrospective cohort study of 71 patients admitted to the surgical intensive care unit with severe ARDS with possible H1N1 viral pneumonia between 2009-2010.


In this cohort, the empiric use of anticoagulation involved:

• Systemic heparin anticoagulation (n=39, 55%) versus
• VTE prophylaxis (n=32, 45%).

The overall incidence of thromboembolic events was 37%, much higher than 6% observed in their ICU patients overall. Following evaluation for H1N1 infection, they observed:

• H1N1 positive patients (n=36)
  • Deep venous thrombosis, 28%
  • Pulmonary embolism, 28%
  • VTE, 44%
• H1N1 negative (n=35)
  • DVT, 23%
  • PE, 9%
  • VTE, 29%

Independent risk factors for VTE included:

• H1N1 infection (Odds Ratio, 17.9)
• Bacterial pneumonia (OR, 6.0)
• Vasopressor requirement (OR, 13.1)

Importantly, those with H1N1 who did not receive therapeutic anticoagulation were 33 times more likely to have any VTE event.


“Whereas a relationship between H1N1 influenza and propensity toward thrombotic events has been suggested by clinical reports and animal studies, a relationship between seasonal influenza and thromboembolic complications has previously not been proved. Our data are the first to confirm such a relationship,” she added.


Their study did not observe a reduction in overall mortality with empirical system heparin anticoagulation. However, Dr. Obi suggested, “other benefits to VTE prevention exist, such as elimination of potential post-thrombotic syndrome and pulmonary hypertension.” She notes that “the small sample size and otherwise non-standardized management of the patients may have contributed to lack of mortality benefit.”


Ultimately this follow-up study by a group with significant experience in this area suggests consideration of systemic anticoagulation in critically ill patients with influenza A H1N1 viral pneumonia and severe ARDS.


The full scholarly article is open source until June 30 at JVSVL-H1N1.

 

[glockman]

SVS: Frequent blood clots documented in swine flu patients with ARDS

EMPIRICAL SYSTEMIC ANTICOAGULATION IS ASSOCIATED WITH LESS VENOUS THROMBOEMBOLISM IN CRITICALLY ILL INFLUENZA A H1N1 ACUTE RESPIRATORY DISTRESS SYNDROME PATIENTS, Journal of Vascular Surgery: Venous and Lymphatic Disorders, May 2019.


CHICAGO, Illinois, May 2019 – A new study has found that ICU patients with swine flu and acute respiratory distress syndrome were 33 percent more likely to develop a blood clot if they were not given a blood thinner when admitted.


Since the virus showed up in humans 10 years ago, researchers have noticed the high incidence of mortality, morbidity and health care costs in patients with swine flu, also known as H1N1.


“To our knowledge, this is the first study to document venous thromboembolic events (VTE) incidence in adult ICU patients with severe acute respiratory distress syndrome (ARDS) due to H1N1 viral pneumonia,” noted Dr. Andrea Obi, first author of the report, published in May’s Journal of Vascular Surgery: Venous and Lymphatic Disorders.


‘This high rate of VTE was encountered despite empirical anticoagulation in more than half of our cohort,” she added.


The cohort study from the University of Michigan confirms that the high incidence of venous thromboembolic events (VTE) in patients with H1N1 ARDS (acute respiratory distress syndrome) can be mitigated with empiric anticoagulation upon admission.


The severity of swine flu is manifested by non-pulmonary complications, mainly VTE. In response to a clinical report from the University of Michigan in 2009, The Centers for Disease Control and Prevention issued a warning regarding the “development of a hypercoaguable state and fatal thromboembolic events” for patients with this disease.


The actual incidence of VTE in H1N1 infection is unknown, nor is the therapeutic effect of anticoagulation in this ill patient population.


University of Michigan researchers led by Dr. Lena Napolitano, in a follow up to their 2009 report, performed a single-center retrospective cohort study of 71 patients admitted to the surgical intensive care unit with severe ARDS with possible H1N1 viral pneumonia between 2009-2010.


In this cohort, the empiric use of anticoagulation involved:

• Systemic heparin anticoagulation (n=39, 55%) versus
• VTE prophylaxis (n=32, 45%).

The overall incidence of thromboembolic events was 37%, much higher than 6% observed in their ICU patients overall. Following evaluation for H1N1 infection, they observed:

• H1N1 positive patients (n=36)
  • Deep venous thrombosis, 28%
  • Pulmonary embolism, 28%
  • VTE, 44%
• H1N1 negative (n=35)
  • DVT, 23%
  • PE, 9%
  • VTE, 29%

Independent risk factors for VTE included:

• H1N1 infection (Odds Ratio, 17.9)
• Bacterial pneumonia (OR, 6.0)
• Vasopressor requirement (OR, 13.1)

Importantly, those with H1N1 who did not receive therapeutic anticoagulation were 33 times more likely to have any VTE event.


“Whereas a relationship between H1N1 influenza and propensity toward thrombotic events has been suggested by clinical reports and animal studies, a relationship between seasonal influenza and thromboembolic complications has previously not been proved. Our data are the first to confirm such a relationship,” she added.


Their study did not observe a reduction in overall mortality with empirical system heparin anticoagulation. However, Dr. Obi suggested, “other benefits to VTE prevention exist, such as elimination of potential post-thrombotic syndrome and pulmonary hypertension.” She notes that “the small sample size and otherwise non-standardized management of the patients may have contributed to lack of mortality benefit.”


Ultimately this follow-up study by a group with significant experience in this area suggests consideration of systemic anticoagulation in critically ill patients with influenza A H1N1 viral pneumonia and severe ARDS.


The full scholarly article is open source until June 30 at JVSVL-H1N1.

Since this is the case, why are we only being told publicly about it now? The alveoli is not filled with water, but are compromised by microclots. Not a situation of wet lungs.

 

[eatshitndie]

hemoglobin issues as a result of iron ions going berserk and becuming free radicals.