You'll have to hope that your medical staff knows about these anticoagulation strategies.
Analysis of COVID-19 autopsies reveals many new details about this disease
MedicalXpress Breaking News-and-Events|May 29, 2020
Pathologists
at The Mount Sinai Hospital, at the epicenter of the COVID-19 global
pandemic, have prepared one of the largest, most comprehensive analysis
of autopsies of COVID-19 victims to date, revealing many complex new
details about the disease. The analysis was released on the preprint
server MedRxiv.
"An essential
contribution of pathology is the understanding of the biology of the
disease and the range of organ damage, and for this reason, we decided
to uncompromisingly perform as many autopsies as possible," said Carlos
Cordon-Cardo, MD, PhD, Irene Heinz Given and John LaPorte Given
Professor and Chair of the Lillian and Henry M. Stratton-Hans Popper
Department of Pathology, Molecular and Cell-Based Medicine, and
co-author of the study.
"Post-mortem
examinations (autopsies) are the gold standard for the elucidation of
the underlying pathophysiology of disease. Despite a rapidly growing
body of literature focusing on the clinical impact and molecular
microbiology of SARS-CoV-2, autopsy
studies have comparatively been few and far between," said Mary Fowkes,
MD, PhD, Director of the Autopsy Service, and senior author of the
paper. SARS-CoV-2 is the virus that causes COVID-19.
To
date, the team has performed more than 90 autopsies on deceased
COVID-19 patients at The Mount Sinai Hospital. The published work
analyzes the first 67. Gross anatomical findings were combined with the
clinical history and laboratory data for all 67 patients. Microscopic
examinations were carried out by the team, using special stains,
immunochemistry, electron microscopy, and molecular pathology assays.
COVID-19
was initially conceptualized as a primarily respiratory illness, but
the Mount Sinai analysis laid out in detail that it also causes damage
to the thin layer of cells that line blood vessels (endothelium), which
underlies the clotting abnormalities and hypoxia observed in severely
ill patients who develop multi-organ failure that leads to death in some
patients.
"The physical evidence
we ascertained through our postmortem analyses helps elucidate the
mechanisms behind some of the clinical symptoms observed by physicians
treating COVID-19 patients, including thromboembolisms and neuropsychiatric disorders," says Clare Bryce, MBChB, Associate Professor of Pathology, Molecular and Cell Based Medicine, and, first author of the study.
The
lungs in nearly all cases showed diffuse damage to the alveoli, the
small sacs where oxygen and carbon dioxide are exchanged with the blood.
This damage is the typical microscopic evidence of clinical acute
respiratory distress syndrome (ARDS), with most cases showing fibrin (a
fibrous, non-globular protein involved in the clotting of blood) and/or
platelet thrombi, or clots, to varying extents. This same pathology is
found in most cases of ARDS, including those related to other
coronoaviruses. However, the totality of findings in the autopsy series
as a whole, with blood clots in multiple other organ systems—most
notably the brain, kidney, and liver—reflects endothelial damage as an
underlying process, which would also correlate with the activation of
the coagulation cascade and persistent elevation of blood markers of
inflammation.
The examined brains showed a
surprising scarcity of inflammation, with only a few cases showing small
foci of chronic inflammation. However, a surprising number of cases
showed microthrombi with small and patchy evidence of tissue death
caused by blockage of blood vessels in both peripheral and deep parts of
the brain. These small microinfarcts may explain some of the
psychological changes seen in some COVID-19 positive patients.
This
study brings new light into the pathophysiology of COVID-19, offering
justification for novel treatment plans, including the anticoagulation
strategies being put into effect by clinical leaders including Valentin
Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief at
The Mount Sinai Hospital.
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