“Could half of the patients concern”: the Corona and can trigger dangerous blood clots
At the autopsy of a twelve-Covid-19-patients, physicians law, increased thrombosis and pulmonary embolism. Four patients died directly of their consequences, although it was prior to the death, no notes. Experts explain what these findings mean for future treatment opportunities.
In the past few weeks, legal practitioner at the University hospital Hamburg-Eppendorf (UKE) examined 190 deceased Covid-19-patients. Twelve of them they looked closer, carried out computer tomography. Their conclusion: Seven of the patients had developed thrombosis, so Clot formations, four of which had died of a pulmonary embolism. Prior to her death in the Affected, no such suspicion.
Sars-CoV-2-Virus seems to be, therefore, in the veins to the formation of blood clots lead to as a pulmonary embolism in major pulmonary vessels and acute cardiovascular failure, can lead, said in a UKE-message. This knowledge could change the treatment of Covid-19-patients in the future. Klaus Püschel, Director of the Institute for legal medicine and Stefan Kluge, Director of the clinic for intensive medicine at the UKE, see this as a confirmation of this is to treat patient with blood-thinning drugs.
Püschel calls, for example, that in the treatment increasingly and specifically “on the blood coagulation system and the formation of thrombi” would be dealt with. So that “a more intensive Precaution is taken to ensure that thrombosis and embolism occur.”
Unusual, many patients suffer from thrombosis and pulmonary embolism
Stefan Kluge adds: “We have already seen in routine clinical practice, that Covid-19 in unusually many cases of the disease to thrombosis and pulmonary embolism in patients has led to. The confirmation now have supplied sections of the deceased. These important instructions, we will transfer in the treatment of the Corona-patient and weigh up carefully whether patients could be primarily treated with a Blood thinner“.
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Discussion of prophylactic treatment with anticoagulants
The treatment agents for blood-thinning is present, however, controversial. Other scientists, such as Clemens Wendtner, chief of infectious diseases and tropical medicine, hospital Munich Schwabing, hold a discussion, while useful, recommend but first, a further study of the virus infection.
Patients should initially be treated with a very low dosage of Blood thinners, such as Heparin. After further investigations, such as computed tomography scan and the determination of various parameters in the blood could increase the dosage. “It must be assumed that the clotting disorders about half of all the Covid-19-may affect patients”, he says.
The exact mechanism, which enable the damage in the organs and vessels of the trigger and the the virus infection, and critical factors for the clotting tendency, but needs to be further investigated.
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“Still too early to draw from these initial observations, the therapeutic conclusions”
This opinion is also Matthias Kochanek, head of is internal intensive care medicine for Internal medicine at the University hospital of Cologne. From the previous study results, derive recommendations for treatment with Blood thinners, he keeps for early. “We see in our everyday clinical practice of Covid-19 positive patients are also increasingly evidence for procoagulant changes in the Blood. It is still too early to draw from these initial observations, the therapeutic conclusions. It is, rather, to recognize these patterns, and with larger Numbers of patients, and possibly also for clinical trials.“
To treat in General, all Covid-19-patients using coagulation-inhibiting substances, he is not justified. “However, you should perform at least one strict thrombosis prophylaxis.”
Clemens Wendtner, adds that the clotting was due to different triggers. “After it is known that low oxygen increase saturations a clotting tendency, is to achieve a principle in the treatment of Covid-19 patients, an adequate oxygen saturation in the blood,” he explains.
“This is possible, for example, by so-called High-flow oxygen therapies.” In this case, the Patient has high oxygen receive amounts of up to 14 litres per Minute. This will carry a mask, and that he needed invasive ventilation.
The Hamburg study was reviewed by four reviewers
The Hamburg physicians published their findings recently in the journal “Annals of Internal Medicine”, according to the University, it has been tested previously by four independent reviewers.
The results of the study have also been found in other autopsies again, said the Director of the Institute for legal medicine, Klaus Püschel. In the study, only comparatively few autopsies were received, was also due to the time factor, said the chief doctor of the Institute of legal medicine, Jan Sperhake. You would have considered more cases, “we wouldn’t have been fast enough.”
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