Clots that can cause dan­ger­ous con­di­tions in­creas­ingly found in COVID-19 pa­tients

Richmond Times-Dispatch - - HEALTH - BY LIND­SEY TANNER

First came a high fever, drench­ing sweats and mus­cle aches. Then, al­most a month later, a numb­ness that spread down the right side of her body.

Dar­lene Gilder­sleeve thought she had re­cov­ered from COVID-19. Doc­tors said she just needed rest. And for sev­eral days, no one sus­pected her wors­en­ing symp­toms were re­lated — un­til a May 4 video call, when her physi­cian heard her slurred speech and con­sulted a spe­cial­ist.

“You’ve had two strokes,” a neu­rol­o­gist told her at the hospi­tal. The Hop­kin­ton, N.H., mother of three is only 43.

Blood clots that can cause strokes, heart at­tacks and dan­ger­ous block­ages in the legs and lungs are in­creas­ingly be­ing found in COVID-19 pa­tients, in­clud­ing some chil­dren.

Even tiny clots that can dam­age tis­sue through­out the body have been seen in hos­pi­tal­ized pa­tients and in au­top­sies, con­found­ing doc­tors’ un­der­stand­ing of what was once con­sid­ered mainly a res­pi­ra­tory in­fec­tion.

“I have to be hum­ble and say I don’t know what’s go­ing on there, but boy we need to find that out be­cause un­less you know what the path­o­genic [disease-caus

ing] mech­a­nism is, it’s go­ing to be tough to do in­ter­ven­tion,” said Dr. An­thony Fauci, the na­tion’s top in­fec­tious disease ex­pert, dur­ing a med­i­cal jour­nal interview last month.

Doc­tors and sci­en­tists at dozens of hos­pi­tals and uni­ver­si­ties around the globe are seek­ing an­swers while try­ing to mea­sure virus pa­tients’ risks for clots and test­ing drugs to treat or pre­vent them.

Gilder­sleeve said health au­thor­i­ties “need to put out an ur­gent warn­ing about strokes” and coro­n­avirus.

Not know­ing the pos­si­ble link “made me doubt my­self” when symp­toms ap­peared, she said.

Some con­di­tions that make some COVID-19 pa­tients vul­ner­a­ble to se­vere com­pli­ca­tions, in­clud­ing obe­sity and di­a­betes, can in­crease clot

War­nell Vega stands with daugh­ter Aaryelis in Brook­lyn, N.Y. Vega col­lapsed on April 19 from a large clot block­ing a lung artery; doc­tors think it was coro­n­avirus-re­lated.

risks. But many au­thor­i­ties be­lieve how the virus at­tacks and the way the body re­sponds both play a role.

“COVID-19 is the most throm­botic [clot-pro­duc­ing] disease we’ve ever seen in our life­time,” said Dr. Alex Spy­ropou­los, a clot spe­cial­ist and pro­fes­sor at Fe­in­stein In­sti­tutes for Med­i­cal Re­search in Man­has­set, N.Y.

Clot­ting has been seen in other coro­n­avirus in­fec­tions, in­clud­ing SARS, but on a much smaller scale, he said.

Sci­en­tists be­lieve the coro­n­avirus en­ters the body through en­zyme-re­cep­tors found through­out the body, in­clud­ing in cells lin­ing the in­side of blood ves­sels. Some the­o­rize that it may pro­mote clot­ting by some­how in­jur­ing those ves­sels as it spreads.

That in­jury may cause a se­vere im­mune re­sponse as the body tries to fight the in­fec­tion, re­sult­ing in in­flam­ma­tion that may also dam­age ves­sels and pro­mote clot­ting, said Dr. Valentin Fuster, di­rec­tor of Mount Si­nai Heart hospi­tal in New York.

It’s un­clear how many COVID-19 pa­tients de­velop clots. Stud­ies from China, Europe and the U.S. sug­gest rates rang­ing from 3% to 70% of hos­pi­tal­ized COVID-19 pa­tients; more rig­or­ous re­search is needed to de­ter­mine the true preva­lence, the Na­tional In­sti­tutes of Health says.

So­cial dis­tanc­ing may make peo­ple more se­den­tary and more vul­ner­a­ble to clots, par­tic­u­larly older adults, so doc­tors should en­cour­age ac­tiv­ity or ex­er­cises that can be done in the home as a pre­ven­tive mea­sure, the state­ment says.

War­nell Vega got that ad­vice after col­laps­ing at home on April 19 from a large clot block­ing a lung artery. Doc­tors at Mount Si­nai Morn­ing­side think it was coro­n­avirus-re­lated.

Vega, 33, a lunch maker for New York City school­child­ren, spent a week in in­ten­sive care on oxy­gen and blood thin­ners, which he’s been told to con­tinue tak­ing for three months.

“I just have to watch out for any bleed­ing, and have to be care­ful not to cut my­self,” he said.


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