On April 22, I reported on the first large series of autopsies, which showed that blood clots are found in the small arteries of the lungs. The authors of that report suggested the blood clots are responsible for the low blood oxygen (hypoxemia) that occurs in severe COVID-19.
Soon after, news reports surfaced of New York City doctors finding strokes in COVID-19 patients under the age of 50, one as young as 33.
Then I covered naproxen as a possible blood thinner with strong antiviral effects against SARS-CoV-2, the coronavirus that causes COVID-19.
Today, physicians from a collaborative group of NYC hospitals published a preprint* that confirms clotting underlies the strokes.
The authors analyzed data from the stroke databases of four NYC hospitals during the period of March 15 to April 15. The selected COVID-19 patients with ischemic stroke and transient ischemic attack, which is caused by blocks in the arteries that feed the brain. (There are other types of stroke, such as hemorrhagic stroke, that were excluded.)
There were ten patients, and they ranged in age from 27 to 75. In contrast to most studies showing severe COVID-19 patients are more likely to be male, only 40% of these patients were male. 80% of them had preexisting conditions, mainly diabetes and hypertension, but none of them had preexisting atrial fibrillation, coronary artery disease, or cerebrovascular disease. The majority of them reported to the emergency room with neurological deficits rather than respiratory problems. 90% were racial minorities and 60% were African American.
Five had strokes in large blood vessels. Their median age was 46, and the youngest patient was in their twenties. 70% had diabetes and 60% had hypertension. The neurological complaints started between 1 and 21 days after the onset of viral illness. Cough and fever were the most common other symptoms, but three out of the five didn't have any other symptoms before they complained of neurological problems. Three of them had surgical removal of clots. Three of them died, and one was still critically ill at the time the manuscript was submitted.
The other five patients had other forms besides blockage of the large blood vessels. Whereas the first group had a 70% rate of diabetes and 60% rate of hypertension, in this group everyone had either diabetes or hypertension. Their median age was 62. Only one died and three were released and independently functioning.
This is an obviously small sample and there is no evidence that strokes commonly occur in young people. However, the fact that strokes occurred in patients as young as 27 and that the median age of the more severe group (46) was younger than the median age of the less severe group (62) makes this a rare but deeply concerning feature of the virus.
While the preponderance had preexisting conditions that affect vascular health, the fact that two of the ten patients did not have any preexisting conditions makes this even more concerning.
They cite a paper from Wuhan finding 4.9% incidence of ischemic stroke in hospitalized patients, and autopsy studies from New Orleans and from Wuhan finding that clots are found not only in the lungs but also in the liver and kidneys.
This strengthens the view of COVID-19 as a clotting disorder, and demands far greater research into the clotting aspect of the disease and treatments that can mitigate the clotting.
Indeed, the Bronx, NYC hospital associated with Albert Einstein College of Medicine, Montefiore, released a preprint two days ago where they reported systematically evaluating D-dimer in their patients and proactively putting them on anticoagulants where justified.
I will be more intensively looking into natural products that affect clotting now, with nattokinase first on my list. I will report back soon.
Stay safe,
Chris
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I am not a medical doctor and this is not medical advice. I have a PhD in Nutritional Sciences and my expertise is in conducting and interpreting research related to my field. Please consult your physician before doing anything for prevention or treatment of COVID-19, and please seek the help of a physician immediately if you believe you may have COVID-19.
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*Footnotes
* The term “preprint” is often used in these updates. Preprints are studies destined for peer-reviewed journals that have yet to be peer-reviewed. Because COVID-19 is such a rapidly evolving disease and peer-review takes so long, most of the information circulating about the disease comes from preprints.