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THREAD: There's a growing body of data to strongly suggest #COVID19 predisposes to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation. This may explain some of rapid decline patients experience 1/n
Provider urgently need good data to guide practice. Reports on incidence of thrombotic complications are limited. Doctors weren't routinely doing pulmonary embolism studies or echocardiograms, in part because protocols were to limit patient contact as a way to control spread. 2/n
One new study looked at 184 ICU patients with proven #COVID19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%), 139 (76%) were still on ICU on April 5th. It found 31% incidence of thrombotic complications in ICU patients. Remarkably high 3/n https://www.sciencedirect.com/science/article/pii/S0049384820301201
Other analysis from China describe cardiomyopathy. There's limited reporting on the cases. Growing awareness of thrombotic events raise question of whether some of the incidence of heart strain in setting of hypoxia could be result of pulmonary emboli? 4/n https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
One etiology may be #COVID19-associated coagulopathy (CAC). Patients with severe COVID-19 infection can develop clotting events meeting criteria for DIC criteria with fulminant activation of coagulation, resulting in widespread microvascular thrombosis 5/n https://www.hematology.org/covid-19/covid-19-and-coagulopathy
Data previously published by hematologists from Wuhan, China indicated that abnormal coagulation parameters can be a useful predictor of prognosis in pneumonia due to #COVID19 (Tang et al, 2020). 6/n https://b-s-h.org.uk/media/18151/dic-score-in-covid-19-pneumonia_19-03-2020.pdf
This clotting phenomenon may, in certain cases, explain rapid decompensation some doctors describe, where patients will become acutely hypoxic and require urgent intubation. Providers tell me they are now more routinely doing studies for pulmonary emboli in these settings. 7/n
