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1/ #Frontline clinicians across the world are observing a #hypercoagulable state in patients with #COVID19. Could the severe and varied effects of the disease on multiple organ systems possibly be due to thrombus/micro-thrombus and associated sequela? @ASH_hematology @EricTopol
2/ Could a mechanism of #microvascular injury during the infection be through inappropriate effects of excess free angiotensin-II protein floating around because the ACE-2 that would normally be soaking it up is occupied by #SARSCOV2 particles? @EricTopol @ASH_hematology
3/ We know that ACE2 activation promotes antithrombotic activity and ACE2 deactivation would promote thrombus. #medtwitter #NurseTwitter #COVIDー19…
4/ I was also thinking about the patient populations effected:

Men —> more ACE2

Post menopausal women —> more ACE2

Pregnant women —> higher risk for clot —> ACE2 expression increases in normal pregnancy 2nd trimester

Diabetes, HTN, Smoking —> preexisting vascular damage
5/ So are the people that are more susceptible to #SARSCOV2 those with more ACE2 receptors at baseline? @ASH_hematology @EricTopol #medtwitter #nursetwitter
6/ The most striking reports have been interviews with clinicians on the front lines:

Neurology Today (Italy interview):
"There is a dramatic increase in the number of vascular events, ischemic strokes, and thrombosis..."…
7/ Another interview with an Italian anesthesiologist:
“We are performing daily echo on our patients in the ICU. We are seeing a number of patients with echo signs of pulmonary embolism (dilated right ventricle, tricuspid regurgitation). These patients are typically in the ICU...
8/…These patients are not necessarily ones who have been immobile in the ICU. We think this is because #COVIDー19 causes a massive hypercoagulable state, many patients have D-dimer levels extremely high on presentation..."…
9/ Additional studies have also recently come out, including:

Abnormal Coagulation Parameters Are Associated With Poor Prognosis in Patients With Novel Coronavirus Pneumonia (China)

Anticoagulant Treatment Is Associated With Decreased Mortality in Severe Coronavirus Disease 2019 Patients With Coagulopathy (China)
Acute aero-ischemia in the child at the time of COVID19 (Italy)…

COVID19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism (China)…
12/ @ASH_hematology recommends: "All hospitalized patients with #COVIDー19 should receive pharmacologic thromboprophylaxis with LMWH or fondaparinux (suggested over unfractionated heparin to reduce contact) unless patient has increased bleeding risk."…
13/ @farid__jalali proposed a theory that has been widely circulated on @Facebook.…
14/ Another theory by @VectorSting
"Physiology of COVID19 pneumonitis has the gist of shunt way out of proportion to lung injury. This suggests specific dysregulation of the pulmonary vascular compartment. Here is a hypothesis to explain why this might be the case..."
15/ Lastly, I am a Women’s Health NP. I fully acknowledge that I am not an infectious disease specialist, epidemiologist, immunologist, cardiologist, geneticist, or physician.

I just keep asking questions.

Have to do something with my COVID-induced insomnia #WhenImUpAtNight
16/ Forgot to include one interesting study from Italy!

ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy…
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@janevandis In the same headspace, I am planning on doing a deeper dive into the OB data that @jimgthornton has so wonderfully put together. I am very concerned about the preterm labors, women with pre-existing HTN and DM, hemorrhage/clot risk and mothers undergoing CS
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