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