First he had a fever, strong sweats and muscle aches. Almost a month later, a strange numbness on the right side of the body.
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Darlene Gildersleeve thought she had recovered from covid-19. The doctors told him that he only needed rest. For several days, no one suspected that the worsening of his symptoms was related until, during a videoconference on May 4, his doctor noticed that he was slurring the words and consulted a specialist.
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“You have had two strokes,” a neurologist told Gildersleeve in a hospital. The Hopkinton, New Hampshire woman is only 43 years old.
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Thrombi, which can cause strokes, heart attacks, and dangerous arterial blockages in the legs and lungs, are increasingly found in covid-19 patients, including some children. Some tiny ones that can damage tissues of any part of the body have even been detected in hospitalized patients and at autopsies, attacking doctors’ understanding of what was once considered primarily a respiratory infection.
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“I must be humble and say that I do not know what is happening there, but boy do we need to find out because, unless you know what the pathogenic mechanism (causing the disease) is, it will be difficult to intervene,” said Dr. Anthony Fauci, America’s leading infectious disease expert, during an April interview with a medical publication.
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Doctors and scientists from dozens of Hospitals and universities around the world are searching for answers while trying to determine a patient’s risk of thrombus. and try drugs to treat or prevent them.
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Gildersleeve said that health authorities “urgently need to alert about strokes” and the coronavirus. Not knowing the possible link “made me hesitate” when symptoms occurred, he added.
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Other conditions such as obesity and diabetes, which make people with COVID-19 vulnerable to more severe complications, may increase the risk of thrombi. However, many authorities believe that there is a relationship between the way the virus attacks and the way the body reacts.
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“Covid-19 is the most thrombotic disease (causing blood clots (or thrombi) within the body) that we have ever seen in our lives”said Dr. Alex Spyropoulos, a thrombosis specialist and professor at the Feinstein Institutes of Medical Research in Manhasset, New York.
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Thrombi have also been noted in infections with other coronaviruses, such as SARS, but on a much smaller scale, he said.
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Scientists believe that the coronavirus enters the body through enzyme receptors throughout the body, including the cells that line the inside of the blood vessels.
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Some theorize that the coronavirus may promote clotting because it somehow injures those vessels during their spread. This injury can provoke a severe immune response from the body when trying to fight the infection., which generates inflammation that can also damage blood vessels and promote clotting, said Dr. Valentin Fuster, director of Mount Sinai Heart Hospital in New York.
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How many coronavirus patients develop thrombi is unknown. Studies from China, Europe and the United States indicate a rate of between 3% and 70% of people hospitalized with COVID-19. More rigorous research is needed to determine true prevalence, said the National Institutes of Health.
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The prevalence in patients with moderate symptoms is unknown, and The agency notes that there is insufficient evidence to recommend routine thrombus testing to all covid-19 sufferers who do not have symptoms of thrombosis., such as swelling, pain, and reddish discoloration in an arm or leg.
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Some hospitals have found that 40% of covid-19 patient deaths are from thrombi. Spyropoulos said this has been a constant in his system of 23 hospitals in the New York metropolitan area, Northwell Health, which has treated more than 11,000 patients with COVID-19. Cases there have been cut by almost half in the past month, allowing more time for research before a second and perhaps third wave of infections can occur, he said. “We are in a race against time to find an answer to the main clinical questions,” he added.
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People hospitalized with any severe illness face increased risks of thrombus, in part due to confinement in bed and inactivity. Ordinarily they supply anticoagulants as a preventive measure. Some doctors are even testing higher-than-usual doses preventively in hospitalized patients with coronavirus.
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A few have provided powerful thrombus-dissolving medications that are typically used to treat strokes, and have had mixed results. In a recommendation issued May 12, the National Institutes of Health said further research is needed to see if that strategy has any benefit.
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Fuster participated in a preliminary investigation of almost 2,800 COVID-19 patients in five hospitals in the Mount Sinai system. A look at the results indicates slightly higher odds of survival in intubated patients who received anticoagulants compared to those who did not.
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Although the results are not conclusive, all covid-19 patients in Mount Sinai receive anticoagulants unless they are at risk of bleeding, a possible side effect, Fuster declared.
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Some covid-19 patients, such as Gildersleeve, develop dangerous thrombi when their infections appear to have subsided, Spyropoulos said. Seriously ill patients cared for at Northwell are sent home with an indication to take blood thinners, and their experiences will be included in a study to be published soon. Spyropoulos has been a paid consultant to Janssen Pharmaceuticals, maker of Xarelto, the brand name of the anticoagulant.
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Further, Northwell participates in a multicenter study that will test the use of anticoagulants in patients with COVID-19 that are not serious enough to require hospitalization.
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In a small study published May 15, doctors at the University of Colorado concluded that the combined results of two tests that measured blood clotting markers can help determine which patients will develop dangerous thrombi. One test measures a protein fragment called a D-dimer, a residue from dissolved thrombi. High levels of the protein are sometimes indicative of dangerous thrombi formed deep in the veins in the legs and reaching the lungs or other organs.
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Due to concerns about thrombi in COVID-19 sufferers, an international group of doctors and researchers issued a 30-page consensus statement. Bikdeli is the main author.
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Tests to detect thrombi that require treatment include x-rays or ultrasound exams, the document says, but pose a danger to health workers because the virus is highly contagious. Bikdeli expressed fear that, if protective equipment is lacking, some dangerous thrombi will go undiagnosed and untreated.
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Social distancing could increase people’s sedentary lifestyle and their vulnerability to thrombi, particularly in older adults, so doctors should encourage activity or exercises that can be done at home as a preventive measure, according to the statement.
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Warnell Vega received that recommendation after losing consciousness at his home on April 19 due to a large thrombus that obstructed a pulmonary artery. Doctors at Mount Sinai Morningside believe the problem was related to the coronavirus. Vega, 33, who prepares lunches for school children in New York City, spent a week in intensive therapy with oxygen and anticoagulants, which should continue taking for three months on medical recommendation. “I must be very alert that no bleeding is coming and be careful not to cut,” said Vega.
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Gildersleeve, the New Hampshire embolism patient, was also sent home with an indication to take blood thinners. Do physical therapy to strengthen and improve your sense of balance. You still have some numbness and vision problems, so you shouldn’t be driving a vehicle at this time.
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Doctors cannot predict when or if he will be able to regain all of his skills.
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