COVID-19 & Micro Embolism – Day 18, Thoughts About The Pandemic

Can Anticoagulants Protect Against Getting Severe/Critical COVID-19 Pneumonia?

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden.

What we are not seeing at our ward (AVA) is any COVID-19 patients with atrial fibrillation. Usually at least half of our patient monitors are filled with irregular rhythms.

Now there is not a single one (at least not who is also positive with COVID-19, which most patients at the ward are).

These patients all have perfectly regular sinus rhythms.

Which makes us ask ourselves a similar question as the one posted two days ago regarding STEMIs: WHERE ARE ALL THE PATIENTS WITH ATRIAL FIBRILLATION?

One theory is: what if anticoagulants protect against the complications associated with a COVID-19 infection?

What if it all fits?

The fact that SARS-CoV-2 seems to cause a cytokine storm (with IL-6 being activated & elevated among other cytokines), and the elevation of D-Dimer, and the fact that these patients simply seem more prone to get embolisms.

Add to that the fact that the patients in the high risk group also seem to have, already, elevated risk for thromboembolism with risk factors such as: smoking, hypertension, obesity, and age.

What if all the pulmonary complications we are witnessing in the hospital are due mostly to microembolism in the lungs?

What if those already on anticoagulants are protected and that’s why we are not seeing patients with atrial fibrillation being admitted to the same extent as we have previously?

What if that, to some extent, also explains the decline in STEMI patients as many of the patients seeking for chest pain might already be on anticoagulants if they had STEMI previously?

Many questions, a theory that seems to fit, but research is needed to get us from guess work to facts.

Until then, since 9th of April we have new guidelines regarding treatment with anticoagulants where basically anyone positive with SARS-CoV-2 with thrombocyte levels that are adequate are administered LMWH from day one.

The patients who are in need of high levels of oxygen or NIV (non-invasive ventilator) or intensive care are administered double the standard prophylactic dose.

It all seems to fit (however, beware of the high risk of confirmation bias!) – have we finally made a breakthrough regarding the best treatment regimen?

Lets see if the data & research, going ahead, also confirms our theory.

COVID-19 Numbers Sweden 2020-04-11 *

887 deaths nationally
- 523 of them in Stockholm
10 151 confirmed cases nationally
DEATHS [SWE]

New confirmed deaths daily in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
ICU [SWE]

New Covid-19 patients Being Treated at the ICU in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
NEW CONFIRMED CASES [SWE]

New confirmed cases daily in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
TOTAL CONFIRMED CASES [SWE]

New confirmed cases accumulated over time in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
Intensive care Sweden: *
- 774 COVID-19 confirmed patients treated in the ICU in total so far
- 10,4 days from symptoms to ICU
- 23,6 % women
  
  Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 → 24 → 129 → 424 → 753 → (997 this week up until now, however since it’s only saturday this weeks numbers are yet incomplete)