Thread by @loscharlos

“Cells & tissues that control blood flow are damaged & the blood’s tendency to clot is amplified. #MicroClots, leftover from the viral assault or fueled by its aftermath, might be gumming up the body’s circulation, to disastrous effect” #LongCovid science.org/content/articl…

“In some patients we have specific areas where no blood flow comes in” or the flow is reduced, Buonsenso says. Is that driving their lingering symptoms? “I can’t say this is the truth, of course. But this makes sense.” #LongCovid

“Where there should have been bright oranges and yellows, signifying pulsing blood, one lung was nearly completely blue, indicating little flow. Buonsenso believes #MicroClots or chronic damage to the lining of blood vessels may be impairing blood flow.” #LongCovid

“The knotty question is what to do next. Buonsenso’s patients don’t meet the current criteria for taking anticoagulant drugs that prevent blood clots or keep them from getting bigger, because no clots are visible on their scans.” #LongCovid

“With seriously ill children in front of him, Buonsenso didn’t want to wait to launch a clinical trial… All five patients are now taking anticoagulants—which carry the risk of severe bleeding—under close monitoring… He’s heartened by their progress. Several are back in school”

“@MartaEsperti was one of the first #LongCovid patients in Europe to receive a lung SPECT-CT scan, & it looked just like the compromised lungs of the sick children Buonsenso scanned later. ‘My right lung is almost completely blue,’ she says.”

“@MartaEsperti doctors believe damage to tiny blood vessels & #MicroClots are the culprit. The theory of persistent microclots gained further credence in the summer of 2021, when @resiapretorius & colleagues reported such clots could linger in the blood of #LongCovid patients.”

“@resiapretorius team found signs of #MicroClots in people with #LongCovid, but not in healthy people. One challenge facing clinicians keen to hunt for microclots in blood is that detecting them is a laborious process, although Pretorius is working to make it more accessible.”

“The work by @resiapretorius an emerging pattern in which biology of acute & chronic COVID-19 overlap. Early in the pandemic drs recognized blood clots as a signature of early, severe illness.. Even people with milder disease were at heightened risk of heart attacks & strokes.”

“The two diseases—acute COVID-19 and #LongCovid—‘aren’t very different,’ posits @DaveLeeERMD. He suspects #MicroClots explain many chronic symptoms.. Tiny clots in the brain could explain cognitive troubles, or clots may kill small fiber nerve cells & drive @Dysautonomia.”

“‘I oscillate in my excitement’ for #LongCovid theories, says @PutrinoLab.. Right now, his enthusiasm for the #MicroClots hypothesis is running high.. that team has preliminary data to suggest the amount of micro clots in blood correlates with the severity of Long Covid symptoms”

“All agree that solo operators are unlikely. Lingering virus, for example, could attack the circulatory system, triggering blood clots or chronic inflammation. ‘I see this as a triangle,’ Buonsenso says, with each trigger potentially explaining, or even amplifying, the others.”

For @microbeminded2 and others, fitting the puzzle pieces together is of urgent concern. “I consider #LongCovid to be a massive emergency,” she says.

I’ll stop here but this is the best research article I have read on #LongCovid since NY Times “how LC exhaust the body” earlier this year.

This article is taking a look at #MicroClots, viral persistence & immune dysregulation. I agree they could be the Holy Trinity.

One of the best research articles I have read on #LongCovid all year. Highly recommend.
@patientled @ahandvanish @WesElyMD @dbkell @luckytran @LekshmiMD @drschweig @stuartamalcolm @jencurtinmd @MVGutierrezMD @denise_dewald @LongCovidSOS @LongCovidKids @Bob_Wachter @EricTopol

Great coverage here #TeamClots: @doctorasadkhan @dbkell @HarryLeeming @clarejdaly @gezmedinger @DrAnnaNZ @ApheresisLC @fearnley_k

@VirusesImmunity @lisa_iannattone @DrPanMD @DrEricDing @EdoajoEric @calirunnerdoc @DrRupaMarya @danaparish @elisaperego78 @bcdelaney1 @BiologistBunk @chrischirp

@gregggonsalves