But if you were to extrapolate the damage seen in the micro-capillaries in lungs to the brain then this would be like the silent infarcts that kill off small parts of the brain. So you need immediate prevention therapies to prevent that damage.
More evidence that Covid-19 is a disease of clotting
This line from here is really concerning;
Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza.
Aspirin? warfarin? Lovenox? Don't listen to me, I'm not medically trained, so ask your doctor EXACTLY HOW TO PREVENT SUCH DAMAGE. You'll need this before the additional research is completed. I would immediately tell my doctor to get warfarin going and get a Lovenox injection to cover the problem before the warfarin kicks in.
The takeaway is don't get COVID-19.
The latest here:
Stroke rates among COVID-19 patients are low, but cases are more severe
The rate of strokes in
COVID-19 patients appears relatively low, but a higher proportion of
those strokes are presenting in younger people and are often more severe
compared to strokes in people who do not have the novel coronavirus,
while globally rates for stroke hospitalizations and treatments are
significantly lower than for the first part of 2019, according to four
separate research papers published this week in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.
In
"SARS2-CoV-2 and Stroke in a New York Healthcare System," researchers
reported key demographic and clinical characteristics of patients who
developed ischemic stroke associated with the COVID-19 infection and
received care within one hospital system serving all five boroughs of
New York City.
During the study period of
March 15 through April 19, 2020, out of 3,556 hospitalized patients with
diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging-proven
ischemic stroke. They compared those 32 patients admitted with stroke
and COVID-19 to those admitted only with stroke (46 patients) and found
that the patients with COVID-19:
- tended to be younger, average age of 63 years vs 70 years for non-COVID stroke patients;
- had more severe strokes, average score of 19 vs 8 on the National Institutes of Health Stroke Scale;
- had higher D-dimer levels, 10,000 vs 525, which can indicate significant blood clotting;
- were more likely to be treated with blood thinners, 75% vs 23.9%;
- were more likely to have a cryptogenic stroke in which the cause is unknown, 65.6% vs 30.4%; and
- were more likely to be dead at hospital discharge, 63.6% vs 9.3%.
Conversely,
COVID-19 stroke patients were less likely than those stroke patients
without the novel coronavirus to have high blood pressure (56.3% vs
76.1%) or to have a prior history of stroke (3.1% vs 13%).
The
researchers observed that the rate of imaging-confirmed acute ischemic
stroke in hospitalized patients with COVID-19 in their New York City
hospital system was lower compared to prior reports in COVID-19 studies
from China. One reason for the difference might be related to variations
in race/ethnicity between the two study populations. In addition, the
low rate of ischemic stroke with COVID-19 infection may be an
underestimate because "the diagnosis of ischemic stroke can be
challenging in those critically ill with COVID-19 infection who are
intubated and sedated," said lead study author Shadi Yaghi, MD, FAHA, of
the department of neurology at NYU Grossman School of Medicine in
Manhattan.
Yaghi said, "It was difficult to
determine the exact cause of the strokes of the COVID-19 patients,
however, most patients appeared to experience abnormal blood clotting.
Additional research is needed to determine if therapeutic
anticoagulation(Aspirin? warfarin? Lovenox?) for stroke is useful in patients with COVID-19." The
researchers noted that at least one clinical trial is already underway
to investigate the safety and efficacy of treatment for active clotting
vs preventive treatment in certain patients with COVID-19 infection
presenting with possible clotting indicators.
Yaghi
and his coauthors also noted the number of stroke cases with COVID-19
seems to have peaked and is now decreasing. This finding may be related
to the overall reduction in COVID-19 hospital admissions, which may be
due to social distancing and guidance for people to stay at home. In
addition, the number of stroke patients hospitalized during the study
period was significantly lower than the same time frame in 2019.
Similar trends are reported in several other studies also published this week in Stroke,
reflecting a global disruption of emergency health care services
including delayed care and a lower-than-usual volume of stroke
emergencies during the COVID-19 pandemic crisis.
In
a Hong Kong study, "Delays in Stroke Onset to Hospital Arrival Time
during COVID-19," by lead author Kay Cheong Teo, MBBS, researchers
compared the stroke onset time to hospital arrival time for stroke and
transient ischemic attack (TIA) patients from January 23 to March 24,
2020 (the first 60 days from the first diagnosed COVID-19 case in Hong
Kong) to the same time period in 2019. In 2020, 73 stroke patients
presented to Queen Mary Hospital compared to 83 in 2019. However, the
time from stroke onset-to-arrival time was about an hour longer in 2020
compared with last year (154 minutes vs 95 minutes). In addition, the
number of patients arriving within the critical 4.5-hour treatment
window dropped from 72% in 2019 to 55% in 2020.
Also
from China, "The impact of the COVID-19 epidemic on stroke care and
potential solutions," by lead author Jing Zhao, MD, PhD, detailed survey
results from more than 200 stroke centers through the Big Data
Observatory Platform for Stroke of China, which consists of 280
hospitals across China. They found that in February 2020, hospital
admissions related to stroke dropped nearly 40%, while clot-busting
treatment and mechanical clot-removal cases also decreased by 25%,
compared to the same time period in 2019. The researchers cited several
factors likely contributed to the reduced admissions and prehospital
delays during the COVID-19 pandemic, such as lack of stroke knowledge
and proper transportation. They also noted that another key factor was
patients not coming to the hospital for fear of virus infection.
In
a fourth study, "Mechanical Thrombectomy for Acute Ischemic Stroke Amid
the COVID-19 Outbreak," by lead author Basile Kerleroux, MD,
researchers in France compared patient data from stroke centers across
the country from February 15 through March 30, 2020 to data of patients
treated during the same time period in 2019. They found a 21% decrease
(844 in 2019 vs. 668 in 2020) in overall volume of ischemic patients
receiving mechanical thrombectomy during the pandemic compared to the
previous year.
Additionally, there was a
significant increase in the amount of time from imaging to treatment
overall--145 minutes in 2020 compared to 126 minutes in 2019, and that
delay increased by nearly 30 minutes in patients transferred to other
facilities for treatment after imaging. The researchers said delays may
have been due to unprecedented stress on emergency medical system
services, as well as primary care stroke centers lacking transfer
resources needed to send eligible patients to thrombectomy capable
stroke centers within the therapeutic window. They noted stricter
applications of guidelines during the pandemic period could also have
meant some patients may have not been referred or accepted for
mechanical thrombectomy treatment during that time.
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