Thread by @DrTiffanyL

@bhwords Dr. Beverley Hunt presenting on #COVID19 and #thrombosis. She wants to chronologically review the battles we have fought! #ASH22 1/n

@bhwords This story (clinical presentation) -- a reminder of the patients from the front lines in the beginning and what some docs went through! #COVID19 #ASH22 2/n

@bhwords #COVID19 is the 'perfect suit for VTE' ... inflammation, sticky blood, vessel wall changes. The amazingly high levels of fibrinogen (14g/L! (normal is 2-4g/L)) D-dimers reported on a log scale because of the significant increase. #ASH22 3/n

@bhwords #COVID19 has reminded us that the 'coagulation system evolved as an effector pathway of the immune response: lays down fibrin around bacteria to physically entrap them' - and so anticoagulants don't help much, you need to decrease inflammation! #ASH22 4/n

@bhwords So then we had to decide about how to prevent clotting -- full dose heparin, LMWH prophylaxis, etc -- until the NEJM REMAP-CAP ACTIV-4a and ATTACC paper that showed no diff in critically ill pts, on the wards - highly sig improved outcome with THERAPEUTIC heparin. #ASH22 5/n

@bhwords Remember, this was full dose heparin NOT DOACS -- was this benefit due to its anti-inflammatory effect in moderate COVID? But, there was very poor uptake of this even after it was on guidelines! Why? less morbidity in omicron so less therapies needed?? #ASH22 6/n

@bhwords What about antiplatelet use in #COVID19? Large studies did not show difference with aspirin (and bleeding side effects!) One day, this thread will be written in history. #ASH22 7/n

@bhwords Silver lining! @thrombosisday has seen people understand more about hospital acquired thromboembolism. More awareness of #DVT and #PE #ASH22 8/n

@bhwords @thrombosisday And then #VITT after the Astra Zeneca COVID-19 vaccine w/ cerebral VST events. (1 in 100,000k after adenoviral vaccines). #ASH22 Back then, they chaired a call DAILY with @ProfMakris and more to allow people to come with their cases to get expert advice. Published in NEJM. 9/n

@bhwords @ProfMakris Did you all know that unfortunately there are still patients with #VITT that still have anti-PF4 antibodies around so they are still following those patients and are reluctant to stop their anticoagulation. #ASH22 10/n

@bhwords @ProfMakris What about coagulation in #LongCovid? "Microclots" - Amyloid/ particulate particles seen. Are these causal? Is this reproducible? Is it in lots of patients? Still lots to learn but desperate pts are getting plasmapheresis privately & anticoag/plt. #ASH22 11/n

@bhwords @ProfMakris And ending with a warm reminder - thank you for all those working in thrombosis around the world during this hard time. Thank YOU @bhwords for your work and this beautiful summary. #ASH22 12/12