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Coronavirus’s new mystery: It’s causing strokes in healthy people
“These people are clotting, and we can’t shut it off.”
By Katherine Harmon Courage May 1, 2020, 1:00pm PDT
As more people around the world are infected with Covid-19, we’re learning that the novel coronavirus can not only cause severe respiratory illness, but also can attack just about every major organ system in the body. And lately doctors have been sounding the alarm about a disturbing new outcome: blood clots and strokes, which are striking even healthy young people with no known risk factors — and sometimes no other symptom of the virus.
An April 28 report in the New England Journal of Medicine details the cases of five people, ages 33 to 49, in New York City who had strokes and subsequently tested positive for Covid-19. All of them had large-vessel strokes outside of the hospital before experiencing other severe symptoms of the virus; one of them has since died.
“It was very surprising to see the increase in this large-vessel stroke in young people,” Thomas Oxley, a neurosurgeon at Mount Sinai in New York and a coauthor of the new report, tells Vox. As he explains, “The bigger the vessel, the bigger the stroke.”
“It’s the biggest story emerging” about Covid-19, he adds. The rate of large-vessel stroke victims under 50 they saw was seven times higher than before the pandemic.
Blood clots are also causing other unexpected problems for Covid-19 patients. For example, Broadway actor Nick Cordero, who has been hospitalized since March with severe Covid-19, had his right leg amputated earlier this month after doctors were unable to control clotting there.
And many patients are developing small clots in their lungs, reducing the amount of oxygen they can move into their bodies. For others, their blood is clogging dialysis machines (which has been a problem due to the amount of kidney failure this illness is also causing).
“I’m a hematologist, and this is unprecedented,” says Jeffrey Laurence of Weill Cornell Medical College, who has been in the field for three decades. “This is not like a disease we’ve seen before.”
Nearly every patient he has seen for blood disorders in the past month and a half has had Covid-19. “I’ve never had so many consults in my life. These people are clotting, and we can’t shut it off.”
Doctors and researchers are racing to figure out why this is happening, and how they might be able to best use existing therapies, such as blood thinners, to mitigate it in patients. The clots and strokes also add to the list of potential symptoms some people with Covid-19 might experience early on — and gives another possible reason that the number of coronavirus-related deaths around the country is looking far larger than those officially being counted in hospitals.
What causes blood to clot?
When we get injured, we depend on our blood’s ability to clot to stop the flow of blood. Clotting is a complex process that involves small cell fragments called platelets congregating and changing shape, proteins that help even more cells bind together, and the secretion of substances called blood clotting factors. If any of these processes go off course, people can experience excessive bleeding, which can be life-threatening.
“I’ve never had so many consults in my life. These people are clotting, and we can’t shut it off” On the other end of the spectrum, sometimes clots form inside blood vessels (more rarely, in arteries) without an injury. These can cause serious harm and sometimes death. There are many risk factors for developing internal blood clots, including smoking, obesity, heart disease, and others. And, now, it looks like Covid-19 is a risk factor as well.
Some clots remain in the place where they form and are known as thrombosis. This can cause severe pain and swelling. These clots can also travel to — or form in — a major organ, where they can do even more serious damage.
For example, a clot in the leg can travel up to the lungs, cutting off blood flow and causing a pulmonary embolism (which can lead to death or permanent lung damage). A clot can also flow to the heart, triggering a heart attack. And one in or near the head can block blood flow in part of the brain, bringing on a stroke.
What clots are doing to Covid-19 patients
Small early studies and case reports about the link between the novel coronavirus and blood clots are now pouring in. For example, one team in the Netherlands followed 184 severe Covid-19 patients who were receiving treatment in three different intensive care units. They found that 31 percent of these people had some sort of blood clotting issue, a percentage they call “remarkably high.”
Other data is emerging with similar implications. “In patients with severe disease, various forms of blood clots are estimated to occur in 15-35 percent of patients,” Behnood Bikdeli, a cardiology fellow at Columbia University Medical Center, tells Vox. And these clots, especially the small ones, “could impact the illness severity and involvement of many of the organs,” he says. (He and an international team of dozens of researchers published an April review of clotting issues in the Journal of the American College of Cardiology.)
continues at vox.com |
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