Radiologist @DrGrahamLJ is spot on. In acute COVID19 the anomalous hypercoagulation triggered by the virus IS the disease. Not a secondary consequence of it. We should stop calling it a pneumonia; it’s a vasculopathy. The same process continues in #LongCovid.
Not saying this is the only thing happening in #LongCovid- viral persistence, immune dysregulation, autoimmunity and reactivation of other viruses may be playing a part but it’s clear that the aberrant hypercoagulability is a key feature.
Grey columns are using brightfield microscopy; black are using Thioflavin T
See the difference in size between #LongCovid & control microclots
There were statistically significant differences in mean size, number & other variables
More in the paper!
2/n
Why is this important?
Because flow cytometry is already accessible in clinical settings, unlike fluorescence microscopy which is mainly a research tool.
To those intent on psychologising #LongCovid & #MECFS because ‘there is no biomarker’- let me tell you something as a senior Dr. Many diseases don’t have biomarkers & diagnosis is clinical. Take asthma for example. Symptoms vary between patients. 1/n
Many patients have abnormal exhaled nitric oxide (FeNO) & histamine challenge tests- some don’t. Yet if the patient’s symptoms & signs fit with asthma, we have no hesitation in making the diagnosis. 2/n
There is the well-known example of multiple sclerosis. Many deemed it psychogenic because there was no lab or radiology test that was diagnostic. Until of course the MR scan was invented. 3/n
Treating hospital discharges for 14 days with half a dose of one anticoagulant does NOT mean that ‘anticoagulants are ineffective in #LongCovid’ (HEAL-COVID study) 1/n
-this is a different population to the vast majority of #LongCovid
-the role of the hyperactivated platelet has been totally disregarded
-treatment dose apixaban is 5mg bd, not 2.5mg
-even if the correct population & drugs were used, #LongCovid does not get better in 14 days 2/n
The ramifications of this could be catastrophic. It could shut the door on funding for properly designed anticoagulant trials. And millions will continue to endure agony. I cannot emphasise enough what a serious own-goal this is.
Latest #TeamClots preprint on clotting abnormalities in #LongCovid. We demonstrated that the average levels of 6 inflammatory procoagulatory molecules were significantly higher in the soluble fraction of blood in #LongCovid when compared to controls medrxiv.org/content/10.110… 1/n
These werealpha-2-antiplasmin (A2AP), serum amyloid A (SAA), platelet factor 4 (PF4), E-selectin, von Willebrand Factor (VWF) & platelet endothelial cell adhesion molecule-1 (PECAM-1). The mean A2AP level exceeded the upper limit of the lab reference range in #LongCovid 2/n
Considering that large quantities of these molecules have already been detected inside microclots using proteomics, the elevation in plasma/serum means that total levels of these inflammatory mediators are indeed alarming in #LongCovid 3/n