A mysterious blood-clotting complication is killing coronavirus patients

[brooklynite]

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 she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.

“That’s 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 they’ve 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]

1. It has been found in feces too. Something extra going on with the virus. . . . nt

[roamer65]

5. Same as SARS-CoV-1.

It was in feces for a few months after on some patients.

[JudyM]

11. And spreading from bathroom vents to infect other people.

[Initech]

22. The adult diaper industry is probably going to get a lot more customers after this.

I mean yeah, who'd want to go in a public bathroom right now?

[tblue37]

13. It originated as a digestive virus in bats, so it's not surprising that it shows up in feces, too. n

[ck4829]

2. If you get hospitalized, insist on getting that shot of heparin in the morning

https://www.practiceupdate.com/content/anticoagulant-treatment-is-associated-with-decreased-mortality-in-severe-covid-19-patients-with-coagulopathy/98435

[JudyM]

9. Interesting. Can you access/post the abstract for that cite?

Can’t get in.

[renate]

23. they really should make the COVID-19 articles available to everyone, shouldn't they?

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]

30. Yes, like NYT is graciously doing.

Thanks!

[Mike 03]

3. Terrifying aspect of COVID-19

Autopsies have shown that some people’s lungs are filled with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or a heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes.

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 don’t clot like this.”

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t 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]

4. I think most hospitals are now using blood thinning as part of covid treatment as this

information has been passed through the healthcare community for a few days now.

[NNadir]

6. It makes sense, given the ACE2 target of the virus. n/t.

[JudyM]

10. Have you seen any research/commentary on whether there's differential outcome for those on

ACE inhibitors vs, for example, otherwise-managed cardiac patients?

I’ve had an eye open for that but haven’t spotted anything yet.

[NNadir]

12. I saw a paper, I think in NEJM, saying that ACE inhibitors and ARD's do no harm...

...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]

15. Thanks, this is fascinating even though a horrific situation overall.

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]

19. Well, speaking for myself, I don't miss my dose anymore. Interestingly...

...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]

31. Definitely interesting.

This will be studied for many years. Hopefully we will have vanquished it by then.

[Chemisse]

37. That is so interesting!

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]

18. I'm getting a Combo Le Grande treatment: ARB, ACE Inhibitor, beta blocker, diuretic & oral nitrate.

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]

20. Interesting. Thanks. I'll pick up the reference. n/t.

[NNadir]

25. So I quickly went through the paper. The authors note low statistical power, but that said...

...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]

28. Thank you for the review.

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]

29. ACE vs ACE2

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. Yes, but these co-evolutionary enzymes, which show significant homology, regulate one another.

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]

7. If I get this virus I will not survive. I have almost all of the complications.

I will be staying home no matter what opens up.

[iemitsu]

8. Me too.

[Joinfortmill]

14. This thing is a fucking plague.

[James48]

16. Interesting.

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]

24. I noticed

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]

17. k&r for visibility. n/t

-Laelth

[bronxiteforever]

21. Kick and recommend for visibility

[certainot]

26. something about glyphosphate / roundup

[bucolic_frolic]

27. A species whacking event

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]

32. This is not ONE virus but a whole family of over 30 mutations. Some of those mutants may be more

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]

34. k & r n/t

[Igel]

35. Part of the reason?

https://www.sciencedaily.com/releases/2018/08/180802115657.htm

[James48]

36. Also interesting.

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!