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UPDATE: Coronavirus is the only respiratory virus I have ever encountered that causes inflammation of blood vessels (vasculitis). One of the great challenges in #COVID medicine is understanding why so many of these patients also get blood clots. 1/
In some cases, these clots are fatal. During the first wave of the pandemic, my team and many others focused our attention on factors in the blood to explain this phenomenon (d-dimer, fibrinogen, INR, etc.). Tests didn't solve the mystery.
Subsequent studies and observations have advanced a different idea about clots: It's not the blood, it's the blood *vessels*. A new theory suggests that #coronavirus pathology is similar to Behçet's syndrome, a vasculitis that causes eye and genital problems.
Behçet's patients get clots, too, but they're attributed to lung and blood vessel inflammation, not abnormal factors in the blood. This has important implications for treatment that may be relevant for COVID. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00003-5/fulltext
We avoid blood thinners with Behçet's, focusing instead on immunosuppression, including steroids and tumor necrosis factor blockade. To treat clots, we drive down inflammation. Blood thinners can actually make things worse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840440/
As COVID medicine evolves, we may similarly turn to drugs that decrease vessel inflammation (immunomodulators) instead of blood thinners to treat clots. This year, we will test all sorts of immunomodulators on #COVID patients, including lenzilumab, risankizumab, and anakinra.
This week, I randomized someone to the cenicriviroc arm of a #COVID19 immunomodulator study. It's a drug I had never heard of until recently. But the trial might help explain why blood vessels become inflamed and clots form. It could turn conventional thinking on its head.
Takeaway: We're using blood thinners to treat COVID clots, but that may change. Immunomodulators could be a better option.
Soon we will solve one of the enduring mysteries of the pandemic: Why do some #COVID patients develop life-threatening blood clots and how can we save them?
Soon we will solve one of the enduring mysteries of the pandemic: Why do some #COVID patients develop life-threatening blood clots and how can we save them?
