A mysterious blood-clotting complication is killing coronavirus patients
Source: Washington Post
Craig Coopersmith was up early that morning as usual and typed his daily inquiry into his phone. Good morning, Team Covid, he wrote, asking for updates from the ICU team leaders working across 10 hospitals in the Emory University health system in Atlanta.
One doctor replied that one of his patients had a strange blood problem. Despite receiving anticoagulants, the patient was still developing clots in various parts of his body. A second said shed seen something similar. And a third. Soon, every person on the text chat had reported the same thing.
Thats when we knew we had a huge problem, said Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: It was in as many as 20, 30 or 40 percent of their patients.
One month ago, as the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident that they knew what they were dealing with. 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 theyve since become increasingly convinced that covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.
Read more: https://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/
Bernardo de La Paz
(49,045 posts)roamer65
(36,747 posts)It was in feces for a few months after on some patients.
JudyM
(29,280 posts)Initech
(100,104 posts)I mean yeah, who'd want to go in a public bathroom right now?
tblue37
(65,490 posts)ck4829
(35,091 posts)JudyM
(29,280 posts)Cant get in.
renate
(13,776 posts)Boooooo.
This normally-behind-an-expensive-paywall website did: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-clinical-features-diagnosis-and-prevention
JudyM
(29,280 posts)Thanks!
Mike 03
(16,616 posts)Lewis Kaplan, a University of Pennsylvania physician and head of the American Society of Critical Care Medicine, said that every year, doctors treat a large variety of people with clotting complications, from those with cancer to victims of severe trauma, and they dont clot like this.
The problem we are having is that while we understand that there is a clot, we dont yet understand why there is a clot, Kaplan said. We dont know. And therefore, we are scared.
SiriusXM has a channel called Doctor Radio where you can ask doctors on the front line questions, and I was going to ask them if taking aspirin prophylactically to prevent clotting might be a good idea, but this article basically says it would be worthless.
I'm glad there are articles about this. It is NOT the flu!
yaesu
(8,020 posts)information has been passed through the healthcare community for a few days now.
NNadir
(33,561 posts)JudyM
(29,280 posts)ACE inhibitors vs, for example, otherwise-managed cardiac patients?
Ive had an eye open for that but havent spotted anything yet.
NNadir
(33,561 posts)...and Covid patients should be maintained on them. It did not make any claim about having a beneficial therapeutic effect however, as I recall.
It was about a week back, if I recall, but I haven't followed up.
I would think that a meta-analysis would demonstrate any effect, but I'm not sure that anyone's really looking at it. In fact, as I understand it, high blood pressure is a high risk factor, whether successfully treated high blood pressure is less of a factor, I don't know. Whether being a patient with successfully treated high blood pressure offers a survival advantage, I also don't know.
These drugs act on the receptor, that's all I do know, and I would imagine someone is looking at the point.
JudyM
(29,280 posts)Last I read it could go either way, even research starting into whether introducing these meds could serve as a decoy for the virus. https://www.the-scientist.com/news-opinion/blood-pressure-meds-point-the-way-to-possible-covid-19-treatment-67371
NNadir
(33,561 posts)...out of this, I learned something quite interesting, which is that my personal ACE2 is a mutant form. I coughed like hell on the ACE2 compounds and had to move to ARBs. I came across a paper saying that this is the result of a polymorphism, a mutation in ACE2.
I joked about it here: Trapped in the house with me, I feel for my wife and sons listening to me brag about my ACE2.
Probably if there were an effect, it could also be addressed with a meta-analysis. I don't think there is, but hey, you never know.
I take valsartan, which works great, even though my doctor asked me if I was concerned about the nitrosoamines - which I'm not, since I a chemist and can evaluate the relative risks of Valsartan/nitrosoamines and no Valsartan/poorly treated HBP - and at times I was sloppy about dosing. No more.
It may not help, but it can't hurt.
JudyM
(29,280 posts)This will be studied for many years. Hopefully we will have vanquished it by then.
Chemisse
(30,817 posts)It's amazing how much there is to learn about this virus and the disease it causes. It is as intriguing as it is tragic.
WheelWalker
(8,956 posts)I HOPE someone is looking at the effect of some of these on a Covid-19 infection. I know these drugs are and have been keeping me alive and kicking. I'm not in the least eager to drop any one of them from my daily regimen.
The Wikipedia entry for Angiotensin-converting enzyme 2 has a section relating to how Covid-19 and Ace-2 inhibitors/ARBs might play in the sandbox together, with several cited references if you have access. https://en.wikipedia.org/wiki/Angiotensin-converting_enzyme_2
One reference of note in the Wikipedia entry...
"An April 2020 study of patients hospitalized in Hubei Province in China found a death rate of 3.7% for hospitalized patients who had hypertension and were on Angiotensin Converting Enzyme inhibitors or Angiotensin Receptor Blockers versus 9.8% for hospitalized patients with hypertension not on such drugs, suggesting that the drugs are not harmful and may help against the coronavirus. [35]"
NNadir
(33,561 posts)NNadir
(33,561 posts)...it's certainly encouraging. I thought this might be the case, and happily, so did the authors.
Of course, it's not really a treatment for people with normal blood pressure or hypotensive patients (which includes my wife), but it means that those people who are on BP meds may do better than those not on meds.
(All scientific COVID papers are now open sourced, by the way. The major scientific publishing companies have decided that this should be the case and have stepped up to the plate for humanity.)
WheelWalker
(8,956 posts)My pill box is a heavily burdened vessel but it may serve me well in this instance... any port in a storm, as they say.
Thank you again. Blessings.
RealityBasedNewYorkr
(119 posts)Note that there is a big difference between ACE (which ACE inhibitors work on) which is an enzyme that constricts blood vessels and raises blood pressure vs ACE2 (which the virus uses to enter cells) which dilates blood vessels and lowers blood pressure
NNadir
(33,561 posts)This very recent Covid-19 paper touches on the point: COVID-19: Risk Groups, Mechanistic Insights, and Challenges
It is true that not all blood pressure medicines bind to both, but their regulatory action is conformationally driven, and that, while not proving an association, suggests a rationale for the very tentatively observed case that ACE/ARB inhibitors seem to increase survival rates among patients taking them because they have high blood pressure.
katmondoo
(6,457 posts)I will be staying home no matter what opens up.
Joinfortmill
(14,467 posts)James48
(4,441 posts)I find this aspect to be fascinating- sorry for using this word, but let me explain.
I am a retired US Army Officer, but my specialty was communications, not biological warfare.
That said, this virus is acting very much like some kind of biological weapon, including now this discussion of it's ability to clot blood.
In military weapons, we talk about blood agents being one of the families of chemical weapons-
Blood agents include: Hydrogen cyanide (AC), Cyanogen chloride (CK), and Arsine (SA).
This virus is mimicking the action of a blood agent, by causing the blood to clot, and thereby depriving the individual of oxygen.
I don't know if any other viruses do that- or if this is something entirely new.
This is also consistent with the recent reports about "Covid-19 toes" - where younger people have had sudden circulation problems in fingers and toes. That exactly sounds like something in this virus is activating blood cells to coagulate.
Article about "Covid toes": https://news.northwestern.edu/stories/2020/04/covid-toes-probably-more-rampant-than-we-realize/&fj=1
MosheFeingold
(3,051 posts)They reversed themselves on the "no aspirin" recommendation. I presume this is why.
My understanding is the virus mainly is attacking the blood itself. Specifically, it damages hemoglobin and releases the iron molecule.
The result is the patient effectively suffocates. The secondary result is the free iron wreaks havoc in the body, causing inflammation and damage.
This is much the same as malaria (in one stage of the disease). And hence why hydrocloroquine works sometimes and other times not -- it interferes with the hemoglobin attack AND is a powerful anti-oxidant/anti-inflammatory. (It apparently does little to the virus itself -- just mitigates damage.)
In addition to blood thinners, they are using large doses of injected vitamin C to help with the oxidation.
++++
I don't favor the "made in the lab" theory much (although the pioneer who discovered HIV thinks it is), but the virus is found in a small population of bats in a cave far from Wuhan -- the very bats the lab with the horrid conditions that were revealed recently. The came-from-wet market theory just doesn't have any support.
Laelth
(32,017 posts)-Laelth
bronxiteforever
(9,287 posts)certainot
(9,090 posts)bucolic_frolic
(43,311 posts)I almost said extinguishing, but that would be rare indeed. So this is what's causing the blue toes and rashes, and patients are like that on the inside too.
Perhaps the virus is so good at suppressing immunity that other symbiotic pathogens have free reign, things like other viruses, yeast (there are something like 456 strains), good bacteria?
Ford_Prefect
(7,921 posts)aggressive and virulent than others. They may also take slightly different paths towards the same end, as it were. The clotting may be found more in one set of strains than some of the others is my point.
East and West coast variants seem to have different patterns of infection, effects and side effects. What is predominantly true in Atlanta, or Orlando may vary significantly from Seattle, LA or Phoenix, for instance.
w0nderer
(1,937 posts)Igel
(35,359 posts)James48
(4,441 posts)What really amazes me is how much there is yet to learn about the wonderful creation that is the human body. All the chemical and electrical interfaces that make us who we are, and yet so few of them are actually fully understood, even after centuries of study.
Technology is giving us amazing new insights. I like that!