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KashPrime's profile
Kashif Pirzada, MD
Kashif Pirzada, MD
Kashif Pirzada, MD
@KashPrime

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Kashif Pirzada, MD

@KashPrime

Emergency Physician in Toronto, co-founder of @conquercovid19, @masks4canada, @medscritical; love history/politics and tech. My startup: @theRavenApp. wagmi!

Toronto
masks4canada.org/how-to-properl…
Joined August 2013

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    1. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

      Front-line providers need to consider anti-coagulating their rapidly deteriorating COVID-19 patients. Could it be that severe endothelial dysfunction, resulting in microvascular thrombosis, is playing a major role in the rapid deterioration that we see in days 7-10? 1/

      23 replies 124 retweets 258 likes
      Show this thread
    2. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

      There are a number of anecdotal reports of coincident pulmonary emboli and other clots, and subsequent rapid improvement with anticoagulation and even thrombolysis. commented on here: http://bit.ly/3c1drZN  here: http://bit.ly/2VaSwwP , and here: http://bit.ly/2xZk4Nx  2/

      1 reply 20 retweets 47 likes
      Show this thread
    3. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

      Recent Italian research in this Webinar by ESICM posits two phenotypes, a type 'L' and a type 'H' Type L could be due to pulmonary microthrombosis and leads to a biphasic course with severe deterioration as clots hit multiple organs. https://www.youtube.com/watch?feature=youtu.be&v=x6l-f3-IK-o … 3/pic.twitter.com/zg2lmG06Z3

      ESICM
      2 replies 18 retweets 33 likes
      Show this thread
    4. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

      Covid is a strange beast. Like with @BorisJohnson, pts appear initially stable, are often discharged home, and return in critical condition. Imaging won't see it, and pathology studies would miss microthrombi as end-stage ARDS with DAD will obliterated findings. 4/

      4 replies 10 retweets 36 likes
      Show this thread
      Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

      Dr. @farid__jalali wrote about this theory over a week ago on Facebook, surmising that Covid mimics Dengue in important ways, causing a cytokine storm, IL-6 raises PAI-1, suppresses tPA and leads to microthrombi in the lungs and everywhere. Original post: https://www.facebook.com/permalink.php?story_fbid=10108628781908939&id=25828688 …pic.twitter.com/6NQzEHw6P8

      6:19 PM - 6 Apr 2020
      • 39 Retweets
      • 102 Likes
      • Alejandro Alison Fox-Robichaud, MD SP Quality-Mask-Up. Twila Brase, RN, Author, C19 Quick Reference Guide kshama datar Stephen Waters Natsok Dorje start Gerardo Viveros RGL.
      4 replies 39 retweets 102 likes
        1. New conversation
        2. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          I've simplified his figure here; we've submitted a letter to NEJM to try to get the word out about his theory. We've also released the text with references - which we'll continue to revise as new data comes to light. https://docs.google.com/document/d/1vGeGtByZokFP9fOzUPdSg3XqIn_-ej5UCjhtnJt70-A/edit …pic.twitter.com/sXmgxzqKvx

          Nour Khatib MD, MBA  🇨🇦
          1 reply 26 retweets 46 likes
          Show this thread
        3. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          What are the implications? Likely closer monitoring of stable covid pt's coag state with D-dimer, PTT, TEG. If you see these numbers rising and other inflammatory markers are going down, consider starting heparin, even tPA if in critical state. More research is needed stat 6/

          2 replies 9 retweets 41 likes
          Show this thread
        4. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          As @emupdates mentions, providers are so busy that we have only anecdotes and clinical judgement to rely on, spread by social media. Traditional publication methods will not save the hundreds of thousands who may die in the next few weeks. https://emupdates.com/cv3w/  7/

          2 replies 12 retweets 33 likes
          Show this thread
        5. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          Watching @farid__jalali, a community GI who never forgot his basic physiology, work hard to get us all to listen to a groundbreaking insight into Covid-19 is inspiring. It reminds me very much of Barry Marshall and Robin Warren with H.pylori. Please get the word out there! 8/

          6 replies 18 retweets 65 likes
          Show this thread
        6. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          #COVID19 #SocialDistancing #StayHome #covid19 #coronavirus #coronavirususa #medtwitter #FOAMed #foamcc @masood_sameer @samir_grover @emedtox @EricTopol @sulemaan @ScottGottliebMD @VirusesImmunity @jeremyphoward @realHayman @srrezaie @Laurie_Garrett @iBookCC @emcrit @BogochIsaac

          1 reply 5 retweets 14 likes
          Show this thread
        7. Kashif Pirzada, MD‏ @KashPrime 6 Apr 2020

          @T_Inglesby @drrandywax @EMManchester @zchagla @ketaminh @PhalpherMD @TheSGEM @ACEPNow @CAEP_Docs @uoftmedicine @NourKhatibEM @AndrewDavies66 @TorontoIDDoc @critconcepts @HelenBranswell @jasonvanschoor

          1 reply 5 retweets 10 likes
          Show this thread
        8. Kashif Pirzada, MD‏ @KashPrime 7 Apr 2020

          Here's another paper that provides an algorithm for spotting and treating coagulopathies in Covid patients, and here is their algorithm https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14810 …pic.twitter.com/EVP1jKJJwm

          3 replies 22 retweets 40 likes
          Show this thread
        9. Kashif Pirzada, MD‏ @KashPrime 8 Apr 2020

          This figure graciously shared by @DrBrandon55 shows more targets to test in this theory, and is being studied now jointly between centers in the US and Italy. I'm told also that many NY ICUs are starting to anticoag their patients.pic.twitter.com/mRNx4y4HeR

          4 replies 15 retweets 43 likes
          Show this thread
        10. Kashif Pirzada, MD‏ @KashPrime 10 Apr 2020

          Kashif Pirzada, MD Retweeted Farid Jalali MD

          And now some evidence on autopsy of possibly microvascular thrombosis:https://twitter.com/farid__jalali/status/1248652258549460993?s=19 …

          Kashif Pirzada, MD added,

          Farid Jalali MD @farid__jalali
          Replying to @lewistlc @__ice9 and 5 others
          And the CONFIRMATION from the good old US of A. Microvascular thrombosis in HEART and LUNG. Mic drop honestly. Let’s get to saving lives please. https://www.medrxiv.org/content/medrxiv/early/2020/04/10/2020.04.06.20050575.full.pdf …
          1 reply 4 retweets 16 likes
          Show this thread
        11. Kashif Pirzada, MD‏ @KashPrime 10 Apr 2020

          @emcrit and @iBookCC propose this algorithm based in Cai http://et.al 's paper https://emcrit.org/pulmcrit/dimer-cutoff-covid/ …pic.twitter.com/2GiuX70vcN

          1 reply 5 retweets 13 likes
          Show this thread
        12. Kashif Pirzada, MD‏ @KashPrime 16 Apr 2020

          Kashif Pirzada, MD Retweeted San Raffaele Anesthesia and Intensive Care

          A new name for a new disease: San Raffaele hospital in Milan is calling the syndrome microCLOTS:https://twitter.com/SRAnesthesiaICU/status/1250797241737994242?s=19 …

          Kashif Pirzada, MD added,

          San Raffaele Anesthesia and Intensive Care @SRAnesthesiaICU
          A new disease. A new name #MicroCLOTS. Microvascular Covid-19 Lung vessels Obstructive Thromboinflammatory Syndrome (MicroCLOTS) defined at San Raffaele Hospital in Milan, Italy after treating > 800 severe #COVID19 pneumonia (> 110 in ICU). https://bit.ly/3eopIcV  #FOAMed #FOAMcc pic.twitter.com/8ZVF18Y04u
          3 replies 5 retweets 8 likes
          Show this thread
        13. End of conversation

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