关于Covid-19和中风的5个重要问题

iStock

It seems likepractically every week now, researchers are learning some strange new detail about thenovel coronavirus．唯一清楚的是它如何影响体育ople differently: Some are asymptomatic and don’t even realize they’re sick. Other have mild symptoms. And an unlucky 19% (according to one comprehensive study) are hospitalized with serious or even deadly complications, such as pneumonia, cardiac injury, and/or respiratory failure. Additional reported side effects range from diarrhea and loss of smell to swollen toes.

现在再加上李stabnormal blood clottingandstroke．A series of reports published in leading journals document a small number of COVID-19 patients—all younger adults—who had strokes from blood clotting, with many not considered to be high-risk for serious illness. Some patients reported mild viral symptoms in the days prior to having a stroke, while others showed no noticeable COVID-19 symptoms at all—and didn’t even know they were sick.

“We are still in the learning phase of this disease,” says Rashid Chotani, M.D., vice president for medical affairs at CareLife Medical in Fairfax, VA, noting that researchers are still studying why and how such clotting occurs.

Still, these developments may change the approach to treating people with COVID-19, both in the hospital and at home. Here, we’ll break down what doctors know so far.

How frequently is this happening?

To date, the total number of stroke cases remains low, although reports are accumulating. On April 28, the新英格兰医学杂志documented five cases of severe stroke occurring in COVID-19 patients younger than 50 years old at Mount Sinai Health System in New York City. One patient, a 33-year-old woman, reported experiencing mild coronavirus symptoms—cough, headache, and chills—the week prior. Over a period of 28 hours, she began losing speech and developing numbness in her left arm and leg.

After initially delaying hospital care due to coronavirus fears, she did eventually seek treatment. Doctors discovered she’d had a stroke as a result of blood clotting in her brain. She received emergency intervention and was discharged to a rehabilitation facility.

Within a two-week period, the same study noted, the Mount Sinai Health System saw an additional four patients in their 30s and 40s who had大容器冲程s，以及世卫组织对Covid-19都有阳性。当堵塞影响大脑中的主要动脉时，发生大容器行程或闭塞（LVOS，最致命的中风），切断显着的血液流动。在这五种情况下，患者患有与冠状病毒一致的其他症状。只有卒中症状到达医院 - 虽然一名37岁的男性确实在与Covid-19的家庭成员人接触着众所周知的。

托马斯·奥克斯利，M.D.是西奈山报告的主要作者，在4月22日将其总结在CNN上，在4月份为期两周的时间内，较年轻成年人的突然行程达到七倍。“这些患者的大多数患者没有过去的病史，并在家里有轻度症状 - 或两种情况下，没有症状 - ”讲话，“他告诉出口。在报告发布时，所有五名患者均存活。

NEW: A May 20 study that was led by researchers at NYU Grossman School of Medicine followed 3,556 COVID-19 patients in New York City and Long Island and found that fewer than 1% of those hospitalized with the virus also had a stroke—a figure 4% lower than similar stroke tallies in China. However, while less frequent, these strokes appear to be more serious. Researchers found that patients in the study who had strokes during a COVID-19 infection were younger, suffered worse symptoms, and were seven times more likely to die than other stroke patients without the virus.

Is this a larger trend being seen elsewhere?

Oxley and the report’s other co-authors point to data from Wuhan, China, that revealed how 5% of hospitalized COVID-19 patients had had strokes. A separate study of Irish patients, published on April 30 in the英国血液学杂志, found that COVID-19 is associated with abnormal blood clotting, calledcoagulopathy, which results in a significant increased risk of heart attacks and strokes. Interestingly, in the Irish study, the most common type of blood clotting was noted within the lungs—appearing as hundreds of tiny “micro-clots” that could potentially block oxygen flow in the bloodstream.

An April 28Sciencearticle goes further, speculating that such micro-clotting in the lungs could be the cause of yet another emerging—and puzzling—condition among critically ill COVID-19 patients:沉默的缺氧, where blood oxygen levels are life-threateningly low, yet the patient shows no outward sign of struggling to breathe.

Reports like this are becoming so widespread that a May 1 report in theCanadian Medical Association Journal发现20％至55％的住院Covid-19患者正在经历凝血病。凝血问题可能发生在身体的任何地方。您可能已经听过尼克CORDERO的故事，这是一个百老汇演员，右腿于4月在血凝块在那里形成血液凝块后截肢。在他的冠状病毒战斗最糟糕的最糟糕的昏迷期间被置于医学诱导的昏迷中，在5月1日呼吸了呼吸管，医生说他们对他的预后充满希望。据各种报道，虽然他睁开眼睛睁开眼睛，但他尚未反应。

Are there theories about why blood clotting occurs?

Researchers are scrambling to understand what’s at the root of these troubling new symptoms. The leading theories include:

• Blood-clotting could be caused by the body’s immune response.
  It’s not a new phenomenon to see blood-clotting complications with viruses or bacterial infections. In fact, during the SARS outbreak from 2002 to 2004 in Singapore, large-vessel strokes were reported in a number of patients. Dr. Chotani notes three other viruses notably associated with strokes: varicella zoster virus (VZV), human immunodeficiency virus (HIV), and cytomegalovirus (CMV).

  丹德克玛，M.D.IA IA大学传染病司司长，伊瓦州市，IA，解释了这种病毒驱动的血液凝血作品。“感染引发的炎症会导致凝血异常，”他说，就像血凝块的形成或出血的趋势一样。当我们感染时，身体踢到高速齿轮，炎症反应控制它。在某些情况下，血细胞凝结旨在捕获入侵者，防止其进一步蔓延到整个身体。但有时这些凝块可以松散，前往较窄的船只，并导致更糟糕的问题 - 切断血液流向像肢体一样的关键区域，甚至心脏或大脑。“真正被认为是一种适应性免疫反应，但在许多条件下，免疫反应也可能是病理的或可能比利益造成更多伤害，”Diekema博士解释道。

• This could simply be a direct effect of COVID-19’s disease course.
  While blood clotting in COVID-19 patients is likely caused by the body’s immune reaction, it could also be a direct effect of the virus, according to Dr. Chotani. “It is not clear exactly how there is clotting in COVID-19 patients,” he says. ”It could be from the infection itself.”

• An underlying, unknown condition could put some patients at higher risk.
  Of course, it’s possible the documented patients were at higher risk of blood clotting than most, even if they didn’t realize it. “There are some genetic conditions that can cause people to have a higher propensity to develop blood clots,” Dr. Diekema explains. That’s not to say that only people with these genetic predispositions can get blood clots—and thus far, there have been no studies linking COVID-19 stroke patients to abnormal clotting conditions.

与Covid-19的一项重大挑战是它是一种新病毒，因此研究人员仍然有充足的了解其在体内的影响。“We don’t know as much as we’d like, because most of the information is from case series at this point,” Dr. Diekema says, and not from widespread studies of thousands of patients, which would give researchers a broader picture of why and how such clotting occurs.

How might this affect COVID-19 treatment?

随着Covid-19患者的血液凝血的更多报道，研究人员已经开始研究新的途径来治疗患者。
Dr. Diekema notes one major question on many doctors’ minds. “Should we increase the amount of anti-coagulation[blood thinner]that we give to COVID-19 patients?” In most U.S. hospitals, patients who are bedridden are given something calledthromboprophylaxis低剂量的血液稀释剂,以防止凝血from sitting in a hospital bed all day. Typically, higher doses of blood thinner would be reserved for patients who already have a clot, but it could potentially be used as a preventative measure before any clots appear.

People with milder symptoms, who do not require hospital treatment for COVID-19, could potentially be prescribed a blood thinner if it proves be helpful, Dr. Diekema adds. “These questions are not yet answered, but there are studies starting up now to get to the bottom of whether those provide any benefit.”

In a pre-proof letter in the Journal of theAmerican College of Cardiology, accepted on April 15, Behnood Bikdeli, M.D., notes that blood thinners could increase risk of dangerous excess bleeding, so healthcare providers should proceed with caution in administering this type of treatment to COVID-19 patients. A joint study from the Massachusetts Institute of Technology in Cambridge and the University of Colorado at Denver is currently testing a blood-thinning drug calledtissue plasminogen activator（TPA）在Covid-19患者中严重呼吸窘迫，如果有助于挽救生命，可能会扩大这种治疗。

What do these developments mean for you?

Until researchers have a clear handle on what’s causing abnormal blood clotting, there may not be a lot you can do to lower your risk of it happening to you, should you contract COVID-19. But one thing you can do is monitor your symptoms closely and continue to follow CDC guidelines for social distancing to avoid exposure to the virus.

So, think back to the Irish study that linked low oxygen levels to blood clotting in the lungs, and the phenomenon known as silent hypoxia. With that condition, patients are still able to speak normally and move around on their own—and don’t complain of shortness of breath. “These patients do not have a sensation of breathing problems, although chest X-ray shows pneumonia, and their oxygen saturation level is way below normal,” Dr. Chotani explains.

This silent hypoxia effect is just beginning to be reported in studies and op-eds from medical doctors, causing some to suggest thatpulse oximeters可能在家中使用，以监测其他明显症状的氧气水平。脉冲血氧仪是一种小型设备，可以通过将手指放置在传感器内，告诉您您的氧饱和水平和脉搏率。您可以在家中购买一个在家中使用，但Chotani博士强调允许医生解释数据的重要性。“在家中使用它的人必须咨询他们的初级保健医生，”他说。“不这样做，而不是理解饱和水平和脉冲读数的意思是什么可以让许多人在急诊室中”如果他们误解了设备的结果。

但是，如果您开始体验卒中症状 - 因为任何理由 - 记住首字母缩略词快速地:

• 脸下垂

• Armweakness

• Speechdifficulty

• Timeto call 911

Then, don’t hesitate. Call for an ambulance immediately. The sooner you get to the hospital the better your long-term prognosis will be.

Whether blood clotting and stroke will emerge as significant symptoms of COVID-19 remains to be seen. In the coming weeks and months, we’re sure to learn more about such complications—and, even better, how to both avoid and treat them.

Meet Our Writer

Sarah Ellis

Sarah Ellis is a wellness and culture writer who covers everything from contraceptive access to chronic health conditions to fitness trends. She is originally from Nashville, Tennessee and currently resides in NYC. She has written for Elite Daily, Greatist, mindbodygreen and others. When she’s not writing, Sarah loves distance running, vegan food, and getting the most out of her library card.

What to Read Next

Omicron Is Here. Are You Ready for It?

covid-19可以引起瓦片吗？

COVID Boosters: Everything You Need to Know Right Now

Let’s Talk About COVID-19