5 ms·

Autopsy Findings and Venous Thromboembolism in Patients with Covid-19

42 points by _Microft 6y ago

echelon 6y ago
I've been reading reports that the virus causes endothelial damage to various organ systems and vasculature. I wonder if the virus leaves behind permanent damage even among those who recover. I would hate to get the virus and be left with a permanently weakened heart and lungs. I'm not a doctor or researcher, but it seems like we're still too early in this to know what the long term impact will be.
- 0x11 6y ago
  As someone who nearly died before age 2 from Kawasaki disease, this all sounds so familiar to what I grew up learning about. There have been surges in diagnoses of Kawasaki disease in children since this pandemic began, which has been said to cause long term endothelial damage. There certainly seems to be some link between the two.
- lnsru 6y ago
  There was an Austrian article about recovered divers on HN another day. Their lungs weren’t suitable for diving anymore. This is not the same article, but cites same doctor: https://divernet.com/2020/04/25/covid-19-lung-effects-worry-diving-doc/ https://divernet.com/2020/04/25/covid-19-lung-effects-worry-... Edit: typo
- pjc50 6y ago
  I've heard several anecdotal reports of long-lasting fatigue after a recent infection. Not all of those are confirmed COVID, due to difficulties in accessing testing. And it's too recent to know how long it will last. But it's worrying, since this is a symptom of some other viral infections that's not well understood and can have big quality of life impact.
acqq 6y ago
Most important lines: "Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction–confirmed diagnosis of COVID-19." "Patients: The first 12 consecutive COVID-19–positive deaths."
- _Microft 6y ago
  Yes, this stood out. The same judgement applied to a selection of cases that is not hand-picked (first N cases, except for having to choose a value of N) sounds like a good basis. Maybe something good comes out of this, e.g. saving patients by treating them with anticoagulants preventively or something like that.
- ncr100 6y ago
  Not the first discussion of DVTs and C19, not just Germany. Some rando redditor 'surgeon' (?) weeks ago talked about the virus irritating cells, to me suggesting some cells would succumb, burst and clot.
olieidel 6y ago
[deleted]
- _Microft 6y ago
  I've also been listed on papers just because I was a student intern that conducted a part of an experiment and wrote a few lines describing it. My own paragraphs didn't make it into the published paper but I contributed to the research and was credited for it in the authors list. It does not seem wrong to do that - except if you interpret authoring narrowly as typing things.
throwmNOmd-01 6y ago
Wonder if they checked for people with blood clotting mutations and what it means for this group. I assume an even higher risk? https://en.wikipedia.org/wiki/Factor_V_Leiden https://en.wikipedia.org/wiki/Factor_V_Leiden
MikeOfAu 6y ago
The causes have been explored on medcram. Summary of the process is here: https://www.youtube.com/watch?v=JOlVkES_kC8&feature=youtu.be&t=1262 https://www.youtube.com/watch?v=JOlVkES_kC8&feature=youtu.be...
gwd 6y ago
> Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Would taking small amounts of asprin be a reasonable preventative measure (in addition to more sensible measures like, "staying home" and "washing your hands")?
- elric 6y ago
  In the general population? No. You could give aspirin to the entire population to prevent heart attacks and strokes, and for every life you save from heart attack or stroke you prevent, you'll kill someone else by bleeding in the gut or brain. I don't know what the total risk of a severe outcome from COVID19 is, but the risk of serious bleeds on aspirin is 1/200. That's high. Edit: I should probably add that the aspirin bleeding risk is not "1 aspirin out of 200 causes bleeding", but rather 1/200 people who are on daily aspirin to prevent heart issues will develop serious bleeding.
chiefalchemist 6y ago
Interesting. But we need more deep dives like this. The sample size here is too small.
lihaciudaniel 6y ago
I don't know, now it seems like multiple virus idk if it's really just one imho
pvaldes 6y ago
"Flu" hit me hard at the beginning of the year or end of 2019. Dry cough, etc... "Flu" hit hard my mother that was vaccinated against flu My father, as usual, didn't even noticed any flu. He was following a sintrom preventive treatment... a standard practice in several countries like... mumble, mumble. Let me take a look to something... Uh, oh... "Warfarin was used predominantly in the UK and Italy (74.9% and 62.0%, respectively), phenprocoumon in Germany (74.1%), acenocoumarol in Spain (67.3%), and fluindione in France (61.8 %)". Source (2014): https://www.ncbi.nlm.nih.gov/pubmed/24651882 https://www.ncbi.nlm.nih.gov/pubmed/24651882 How long it would take to cross "anticoagulant type of treatment" databases (including "none") with "killings by covid"?
- narag 6y ago
  I don't follow. Could you ellaborate?
  - pvaldes 6y ago
    We have a single virus, but it does not behave the same. The difference can be structural, but maybe there is a second agent that acts as modifier and is unknown. If we take a look to the countries affected by coronavirus we can easily spot groups. For example, US, Iran or Brazil would fall in the same group IMHO in some aspects. In Europe we could see Germany, then Spain+Swedden+Netherlands, then Italy+UK, and a strange outlier At this moment we don't know where lies the difference between the number of infected cases ending in death in Germany (4% only), Spain (11%), Swedden and Netherlands (12-13%), Italy (13%) or UK (15%). France, the outlier, has a 19%. If we take the official data, France is one of the worst countries to be in Europe and maybe in the planet when you are positive (maybe french people should take extra measures to not enter in that group). Something is happening there. One explanation could be that France has a bigger amount of deaths by frustrated hospital staff leading to a worse care, or even the appearance of solitary "angels of death". The other explanation could be that they are simply missing lots of positives. More than the other countries. This can be accidental or on purpose. If the former they aren't paying enough atention to this point, if the later, they could be simply applying several layers of statistical make-up to their data, maybe for the political goal of keeping the country in a lower position in the worldwide range. In a similar style that what UK did for weeks. In this case, we could wake up one morning to see a +2000 increase in France deathcount. Lets change the subject. It seems that blood clots have a relevant role in mortality. Well, Many countries, in Europe at least, have preventive programs that put a sizeable amount of elders in an permanent anticoagulant treatment to avoid heart attacks. After the link above, It seems that each major group of countries in Europe favour a different product for that, and Italy and UK use the same product. Some products must be better than other by definition. This anomalies warrant further research in my bumbling opinion
jeffrallen 6y ago
Translation: COVID is a bitch. Don't get it, don't transmit it.
- gwd 6y ago
  > Don't get it, don't transmit it. Unfortunately that's not really a tenable long-term strategy.

42 points by _Microft 6y ago

I've been reading reports that the virus causes endothelial damage to various organ systems and vasculature. I wonder if the virus leaves behind permanent damage even among those who recover. I would hate to get the virus and be left with a permanently weakened heart and lungs. I'm not a doctor or researcher, but it seems like we're still too early in this to know what the long term impact will be.

0x11 6y ago
As someone who nearly died before age 2 from Kawasaki disease, this all sounds so familiar to what I grew up learning about. There have been surges in diagnoses of Kawasaki disease in children since this pandemic began, which has been said to cause long term endothelial damage. There certainly seems to be some link between the two.
lnsru 6y ago
There was an Austrian article about recovered divers on HN another day. Their lungs weren’t suitable for diving anymore. This is not the same article, but cites same doctor: https://divernet.com/2020/04/25/covid-19-lung-effects-worry-diving-doc/ https://divernet.com/2020/04/25/covid-19-lung-effects-worry-... Edit: typo
pjc50 6y ago
I've heard several anecdotal reports of long-lasting fatigue after a recent infection. Not all of those are confirmed COVID, due to difficulties in accessing testing. And it's too recent to know how long it will last. But it's worrying, since this is a symptom of some other viral infections that's not well understood and can have big quality of life impact.

acqq 6y ago

Most important lines: "Setting: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction–confirmed diagnosis of COVID-19." "Patients: The first 12 consecutive COVID-19–positive deaths."

_Microft 6y ago
Yes, this stood out. The same judgement applied to a selection of cases that is not hand-picked (first N cases, except for having to choose a value of N) sounds like a good basis. Maybe something good comes out of this, e.g. saving patients by treating them with anticoagulants preventively or something like that.
ncr100 6y ago
Not the first discussion of DVTs and C19, not just Germany. Some rando redditor 'surgeon' (?) weeks ago talked about the virus irritating cells, to me suggesting some cells would succumb, burst and clot.

olieidel 6y ago

[deleted]

_Microft 6y ago
I've also been listed on papers just because I was a student intern that conducted a part of an experiment and wrote a few lines describing it. My own paragraphs didn't make it into the published paper but I contributed to the research and was credited for it in the authors list. It does not seem wrong to do that - except if you interpret authoring narrowly as typing things.

throwmNOmd-01 6y ago

Wonder if they checked for people with blood clotting mutations and what it means for this group. I assume an even higher risk? https://en.wikipedia.org/wiki/Factor_V_Leiden https://en.wikipedia.org/wiki/Factor_V_Leiden

MikeOfAu 6y ago

The causes have been explored on medcram. Summary of the process is here: https://www.youtube.com/watch?v=JOlVkES_kC8&feature=youtu.be&t=1262 https://www.youtube.com/watch?v=JOlVkES_kC8&feature=youtu.be...

gwd 6y ago

> Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Would taking small amounts of asprin be a reasonable preventative measure (in addition to more sensible measures like, "staying home" and "washing your hands")?

elric 6y ago
In the general population? No. You could give aspirin to the entire population to prevent heart attacks and strokes, and for every life you save from heart attack or stroke you prevent, you'll kill someone else by bleeding in the gut or brain. I don't know what the total risk of a severe outcome from COVID19 is, but the risk of serious bleeds on aspirin is 1/200. That's high. Edit: I should probably add that the aspirin bleeding risk is not "1 aspirin out of 200 causes bleeding", but rather 1/200 people who are on daily aspirin to prevent heart issues will develop serious bleeding.

chiefalchemist 6y ago

Interesting. But we need more deep dives like this. The sample size here is too small.

lihaciudaniel 6y ago

I don't know, now it seems like multiple virus idk if it's really just one imho

pvaldes 6y ago

"Flu" hit me hard at the beginning of the year or end of 2019. Dry cough, etc... "Flu" hit hard my mother that was vaccinated against flu My father, as usual, didn't even noticed any flu. He was following a sintrom preventive treatment... a standard practice in several countries like... mumble, mumble. Let me take a look to something... Uh, oh... "Warfarin was used predominantly in the UK and Italy (74.9% and 62.0%, respectively), phenprocoumon in Germany (74.1%), acenocoumarol in Spain (67.3%), and fluindione in France (61.8 %)". Source (2014): https://www.ncbi.nlm.nih.gov/pubmed/24651882 https://www.ncbi.nlm.nih.gov/pubmed/24651882 How long it would take to cross "anticoagulant type of treatment" databases (including "none") with "killings by covid"?

narag 6y ago
I don't follow. Could you ellaborate?
- pvaldes 6y ago
  We have a single virus, but it does not behave the same. The difference can be structural, but maybe there is a second agent that acts as modifier and is unknown. If we take a look to the countries affected by coronavirus we can easily spot groups. For example, US, Iran or Brazil would fall in the same group IMHO in some aspects. In Europe we could see Germany, then Spain+Swedden+Netherlands, then Italy+UK, and a strange outlier At this moment we don't know where lies the difference between the number of infected cases ending in death in Germany (4% only), Spain (11%), Swedden and Netherlands (12-13%), Italy (13%) or UK (15%). France, the outlier, has a 19%. If we take the official data, France is one of the worst countries to be in Europe and maybe in the planet when you are positive (maybe french people should take extra measures to not enter in that group). Something is happening there. One explanation could be that France has a bigger amount of deaths by frustrated hospital staff leading to a worse care, or even the appearance of solitary "angels of death". The other explanation could be that they are simply missing lots of positives. More than the other countries. This can be accidental or on purpose. If the former they aren't paying enough atention to this point, if the later, they could be simply applying several layers of statistical make-up to their data, maybe for the political goal of keeping the country in a lower position in the worldwide range. In a similar style that what UK did for weeks. In this case, we could wake up one morning to see a +2000 increase in France deathcount. Lets change the subject. It seems that blood clots have a relevant role in mortality. Well, Many countries, in Europe at least, have preventive programs that put a sizeable amount of elders in an permanent anticoagulant treatment to avoid heart attacks. After the link above, It seems that each major group of countries in Europe favour a different product for that, and Italy and UK use the same product. Some products must be better than other by definition. This anomalies warrant further research in my bumbling opinion

jeffrallen 6y ago

Translation: COVID is a bitch. Don't get it, don't transmit it.

gwd 6y ago
> Don't get it, don't transmit it. Unfortunately that's not really a tenable long-term strategy.