
At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots.
As the novel coronavirus spread through New York City in late March, doctors at Mount Sinai Hospital noticed something strange happening to patients' blood.
Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.
At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.
"It's very striking how much this disease causes clots to form," Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient's first symptom of COVID-19.
As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.
"Maybe, just maybe, if you prevent the clotting, you can make the disease less severe," said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.
"FUNNY YOU MENTIONED THAT"
In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.
Five were unusually young, under age 49, with no obvious risk factors for strokes, "which is crazy," he said. "Very, very atypical." The youngest was only 31.
At least half of the 32 patients would test positive for COVID-19, Mocco said.
Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.
The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.
Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.
"And I said, 'It's funny that you mentioned that because I feel like all these patients have blood clots in their lungs,'" Poor recalled.
Reich, the hospital president, told Poor about the surge in strokes seen by Mocco and said the two doctors should team up, setting off days of discussions and meetings with the hospital's department heads.
At 2:46 a.m. on Easter Sunday, Poor sent Mocco his first draft of what would become the new treatment protocol.
DOCTORS SHARE FINDINGS
As their wards began to overflow with COVID-19 patients, the Mount Sinai doctors read papers describing similar findings from doctors in China's Hubei province and other hard-hit areas, and discussed them with their peers in phone calls and webinars.
Mocco called neurosurgeons he knows elsewhere in the country. At Philadelphia's Thomas Jefferson University Hospital, Dr. Pascal Jabbour had begun to see a similar surge in strokes among people with COVID-19. The way his patients' blood congealed reminded him of congenital conditions such as lupus, or certain cancers.
"I've never seen any other viruses causing that," Jabbour said.
In Boston, the Beth Israel Deaconess Medical Center began a clinical trial earlier this month to see if tPA, an anti-clotting drug, could help severely sick COVID-19 patients.
Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.
At Mount Sinai, patients in intensive care often receive the blood-thinning agent heparin in weaker prophylactic doses. Under the new protocol, higher doses of heparin normally used to dissolve clots will be given to patients before any clots are detected.
The treatment joins a growing toolbox at the hospital, where some patients are receiving the antibody-rich plasma of recovered COVID-19 patients or experimental antiviral drugs.
The American Society of Hematology, which has also noted the clotting, says in its guidance to physicians that the benefits of the blood-thinning therapy for COVID-19 patients not already showing signs of clotting are "currently unknown."
"I certainly wouldn't expect harps to play and angels to sing and people to just rip out their intravenous lines and waltz out of the hospital," said Reich. "It's likely going to be something where it just moderates the extent of the disease."
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State & District Details
State | Cases | Active | Recovered | Deaths |
---|---|---|---|---|
DistrictCases Akola757 Aurangabad1974 Dhule228 Jalgaon1039 Mumbai45478 Mumbai Suburban5363 Nagpur692 Nashik1575 Palghar1421 Pune9920 Satara629 Solapur1291 Thane13660 Yavatmal150 Ahmednagar190 Amravati291 Beed54 Bhandara41 Buldhana88 Chandrapur32 Hingoli208 Jalna201 Kolhapur646 Latur139 Nanded176 Nandurbar42 Parbhani78 Raigad1462 Ratnagiri350 Sangli145 Gadchiroli42 gondia69 Osmanabad125 Sindhudurg114 Wardha11 Washim13 | 8141854 397 | 2117 161 | 7991302 236 | 148435 |
DistrictCases Chittoor319 Guntur511 Krishna557 Kurnool795 Sri Potti Sriramulu Nell*296 Anantapur428 East Godavari356 Prakasam104 Srikakulam183 Visakhapatnam103 West Godavari199 Y.S.R.205 Vizianagaram23 | 2339142 8 | 35 8 | 2324374 | 14733 |
DistrictCases Bengaluru Rural40 Bengaluru Urban529 Mysuru107 Bagalkote103 Ballari60 Belagavi337 Bidar219 Chikkaballapura149 Dakshina Kannada179 Dharwad61 Gadag45 Kalaburagi669 Mandya346 Tumakuru36 Uttara Kannada95 Vijayapura201 Chamarajanagara0 Chikkamagaluru19 Chitradurga14 Davangere204 Hassan205 Haveri24 Kodagu4 Kolar29 Koppal5 Raichur369 Ramanagara3 Shivamogga67 Udupi1176 Yadgir538 | 4076348 209 | 792 109 | 4035235 100 | 40321 |
DistrictCases North Goa57 South Goa69 | 259489 40 | 212 22 | 255264 18 | 4013 |
DistrictCases Chengalpattu1314 Chennai23324 Kanchipuram503 Madurai322 Namakkal83 Ranipet133 Thanjavur130 Thiruvallur774 Thiruvarur67 Tiruppur116 Vellore71 Virudhunagar185 Ariyalur444 Coimbatore188 Cuddalore477 Dharmapuri15 Dindigul175 Erode75 Kallakurichi324 Kanniyakumari110 Karur88 Nagapattinam99 Perambalur133 Pudukkottai53 Ramanathapuram119 Salem258 Sivaganga46 Tenkasi103 The Nilgiris17 Theni129 Tiruchirappalli119 Tirunelveli433 Tirupathur45 Tiruvannamalai496 Tuticorin333 Villupuram509 Krishnagiri43 | 3596209 99 | 608 26 | 3557551 73 | 38050 |
DistrictCases Kannur357 Kottayam73 Alappuzha76 Idukki40 Kasaragod333 Kollam118 Kozhikode90 Malappuram119 Palakkad224 Pathanamthitta98 Thiruvananthapuram104 Thrissur106 Ernakulam60 Wayanad36 | 6833904 299 | 2471 160 | 6759831 137 | 71602 2 |
DistrictCases Raipur46 Korba100 Balod41 Baloda Bazar85 Balrampur17 Bastar2 Bemetara21 Bijapur2 Bilaspur100 Dantewada0 Dhamtari6 Durg31 Gariyaband10 Janjgir-Champa56 Jashpur77 Kabirdham52 Kanker19 Kondagaon0 Korea39 Mahasamund54 Mungeli87 Narayanpur0 Raigarh47 Rajnandgaon52 Sukma0 Surajpur9 Surguja14 | 1177835 1 | 23 1 | 1163665 | 14147 |
DistrictCases Hyderabad2475 MedchalMalkajgiri75 Ranga Reddy183 Suryapet87 Vikarabad40 Warangal Urban32 Adilabad22 Jagitial77 Jangoan8 Jayashankar Bhupalapally9 Jogulamba Gadwal40 Kamareddy11 Karimnagar17 Khammam26 Kumuram Bheem Asifabad8 Mahabubnagar30 Mancherial43 Medak11 Nalgonda33 Narayanpet3 Nirmal21 Nizamabad76 RajannaSircilla16 Sangareddy26 Bhadradri Kothagudem5 Mahabubabad10 Mulugu3 Nagarkurnool8 Peddapalli5 Siddipet7 Wanaparthy1 Warangal Rural4 YadadriBhuvanagiri40 | 842395 19 | 152 3 | 838132 16 | 4111 |
DistrictCases Baleshwar190 Bhadrak137 Jajapur322 Dhenkanal36 Kalahandi33 Kendrapara164 Khordha238 Koraput16 Sundargarh102 Anugul26 Balangir129 Bargarh16 Boudh34 Cuttack155 Deogarh33 Gajapati61 Ganjam581 Jagatsinghapur91 Jharsuguda8 Kandhamal28 Kendujhar34 Malkangiri20 Mayurbhanj73 Nabarangpur2 Nayagarh86 Nuapada69 Puri103 Rayagada2 Sambalpur16 Sonepur29 | 1336814 11 | 87 | 1327522 12 | 9205 |
DistrictCases Barwani60 Bhopal1880 Dewas140 Dhar132 East Nimar266 Gwalior211 Indore3839 Jabalpur276 Ujjain799 Agar Malwa15 Alirajpur3 Betul35 Burhanpur351 Chhindwara16 Dindori29 Harda4 Hoshangabad37 Khargone196 Mandsaur112 Morena109 Raisen71 Ratlam51 Sagar228 Shajapur39 Shandol14 Sheopur26 Tikamgarh18 Vidisha37 Anuppur22 Ashoknagar13 Balaghat9 Bhind87 Chhatarpur35 Damoh26 Datia12 Guna8 Jhabua14 Katni3 Mandla15 Narsinghpur17 Neemuch319 Niwari0 Panna20 Rajgarh31 Rewa39 Satna24 Sehore12 Seoni2 Shivpuri15 Sidhi17 Singrauli13 Umaria10 | 1055065 5 | 51 1 | 1044237 4 | 10777 |
DistrictCases Ahmadabad17125 Anand107 Arvalli134 Banas Kantha147 Bhavnagar146 Gandhinagar410 PanchMahals107 Surat2311 Vadodara1555 Bharuch56 Botad55 Chhotaudepur37 Dang5 Dohad43 GirSomnath45 Jamnagar63 Kachchh99 Kheda98 Mahesana159 Mahisagar125 Narmada25 Naysari35 Patan105 Rajkot135 SabarKantha101 Surendranagar55 Tapi6 Valsad47 Amreli16 DevbhumiDwarka22 Junagadh31 Morbi4 Porbandar11 | 1280465 303 | 1697 168 | 1267715 134 | 11053 1 |
DistrictCases Ajmer379 Banswara91 Bharatpur563 Jaipur2177 Jhalawar329 Jodhpur1748 Kota503 Nagaur500 Alwar90 Barmer34 Bhilwara250 Bikaner112 Chittorgarh188 Churu81 Dausa61 Dholpur60 Dungarpur374 Hanumangarh31 Jaisalmer53 Jhunjhunu64 Karauli17 Pali352 Rajsamand140 SawaiMadhopur26 Sikar231 Tonk171 Udaipur724 Baran59 Bundi5 Ganganagar8 Jalore164 Pratapgarh14 Sirohi130 | 1315952 46 | 207 15 | 1306084 31 | 9661 |
DistrictCases Faridabad867 Sonipat404 Ambala93 Bhiwani60 CharkiDadri43 Fatehabad38 Gurugram2950 Hisar98 Jhajjar114 Jind38 Kaithal48 Karnal104 Kurukshetra55 Nuh68 Palwal120 Panchkula39 Panipat78 Rohtak145 Sirsa50 Yamunanagar19 Mahendragarh47 Rewari56 | 1057140 53 | 243 39 | 1046183 14 | 10714 |
DistrictCases Agra933 Aligarh215 Amroha80 Bareilly17 Bijnor157 Bulandshahr166 Firozabad190 Gautam Buddha Nagar1119 Kanpur Nagar286 Lucknow386 Mathura129 Meerut504 Moradabad252 Muzaffarnagar117 Rae Bareli78 Rampur203 Saharanpur298 Sant Kabeer Nagar132 Varanasi243 Auraiya37 Ayodhya120 Azamgarh138 Baghpat68 Bahraich73 Balrampur49 Banda27 Basti214 Bhadohi60 Budaun23 Etah52 Etawah46 Ghaziabad794 Ghazipur159 Gonda59 Gorakhpur166 Hapur225 Hardoi49 Jalaun41 Jaunpur194 Jhansi41 Kannauj69 Kasganj16 Kaushambi6 Mainpuri46 Mau48 Mirzapur22 Pilibhit15 Pratapgarh15 Prayagraj30 Sambhal116 Shamli40 Shravasti23 Sitapur32 Sultanpur97 Unnao42 Ambedkar Nagar92 Amethi206 Ballia60 Barabanki168 Chandauli38 Chitrakoot4 Deoria143 Farrukhabad36 Fatehpur3 Hamirpur3 Hathras43 Kanpur Dehat4 Kheri72 Kushi Nagar67 Lalitpur3 Maharajganj85 Mahoba3 Shahjahanpur25 Siddharth Nagar159 Sonbhadra10 | 2128582 77 | 246 62 | 2104686 14 | 23650 1 |
DistrictCases Central4817 East2472 New Delhi3405 North3059 North East1914 North West5463 Shahdara1580 South2329 South East2446 South West2391 West4768 | 2008732 153 | 528 57 | 1981680 96 | 26524 |
DistrictCases Dhubri30 Goalpara19 Marigaon50 Baksa14 Barpeta28 Biswanath16 Bongaigaon12 Cachar80 Charaideo29 Chirang6 Darrang20 Dhemaji47 Dibrugarh61 Dima Hasao86 Golaghat203 Hailakandi57 Hojai89 Jorhat24 Kamrup42 Kamrup Metro276 KarbiAnglong13 Karimganj85 Kokrajhar37 Lakhimpur57 Majuli2 Nagaon143 Nalbari23 Sivasagar20 Sonitpur27 South SalmaraMancachar4 Tinsukia84 Udalguri28 West KarbiAnglong5 | 746104 2 | 4 2 | 738065 | 8035 |
DistrictCases East District3 North District0 South District3 West District0 | 44338 | 7 | 43831 2 | 500 |
DistrictCases Buxar134 Gaya115 Munger188 Patna279 Rohtas256 Arwal52 Aurangabad75 Banka134 Begusarai243 Bhagalpur266 Bhojpur103 Darbhanga143 Gopalganj123 Jehanabad178 Kaimur (bhabua)105 Lakhisarai72 Madhepura82 Madhubani199 Nalanda123 Nawada122 PurbiChamparan138 Purnia135 Saran101 Siwan139 Vaishali87 Araria68 Jamui47 Katihar175 Khagaria253 Kishanganj75 Muzaffarpur96 Pashchim Champaran57 Saharsa88 Samastipur139 Sheikhpura118 Sheohar20 Sitamarhi73 Supaul87 | 851451 7 | 18 6 | 839130 1 | 12303 |
DistrictCases 24 Paraganas North1031 24 Paraganas South281 Darjeeling97 Howrah1435 Jalpaiguri88 Kalimpong18 Kolkata2777 Maldah235 Medinipur East153 Medinipur West159 Hooghly604 Murshidabad125 Nadia139 Paschim Bardhaman70 Purba Bardhaman130 Alipurduar39 Bankura116 Birbhum206 Coochbehar210 Dinajpur Dakshin50 Dinajpur Uttar216 Jhargram9 Purulia66 | 2118945 8 | 64 3 | 2097348 5 | 21533 |
DistrictCases South Andamans33 Nicobars1 North And Middle Andaman1 | 10751 | 0 | 10622 | 129 |
DistrictCases Pondicherry111 Karaikal2 Mahe4 Yanam0 | 176012 2 | 40 | 173996 9 | 1976 |
DistrictCases Anjaw0 Changlang31 Dibang Valley0 East Kameng0 East Siang1 Kamle0 KraDaadi0 KurungKumey0 Leparada0 Lohit3 Longding0 Lower Dibang Valley0 Lower Siang0 Lower Subansiri0 Namsai2 PakkeKessang1 Papum Pare8 Shi Yomi0 Siang0 Tawang1 Tirap0 Upper Siang1 Upper Subansiri0 West Kameng0 West Siang1 | 66891 | 0 | 66595 | 296 |
DistrictCases Dimapur20 Kiphire3 Kohima7 Longleng0 Mokokchung0 Mon8 Peren2 Phek1 Tuensang3 Wokha0 Zunheboto0 | 35988 | 0 | 35206 | 782 |
DistrictCases Dadra And Nagar Haveli20 | 11591 | 0 | 11587 | 4 |
DistrictCases Ranchi148 Bokaro16 Deoghar5 Dhanbad32 Garhwa80 Giridih19 Hazaribagh110 Jamtara2 Koderma58 Simdega48 Chatra1 Dumka5 East Singhbum170 Godda2 Gumla28 Khunti10 Latehar14 Lohardaga8 Pakur4 Palamu27 Ramgarh75 Sahebganj0 SaraikelaKharsawan20 West Singhbhum21 | 442610 5 | 24 5 | 437254 | 5332 |
DistrictCases Gomati74 North Tripura14 Dhalai196 Khowai24 Sepahijala174 South Tripura53 Unakoti49 West Tripura45 | 108034 | 0 | 107094 | 940 |
DistrictCases Kargil77 LehLadakh43 | 29433 | 4 | 29198 | 231 |
DistrictCases Anantnag395 Bandipora175 Shopian255 Srinagar300 Baramulla271 Budgam110 Ganderbal37 Jammu138 Kathua53 Kulgam295 Kupwara231 Rajouri39 Ramban151 Reasi26 Samba25 Udhampur155 Mirpur0 Muzaffarabad0 Doda27 Kishtwar10 Poonch35 Pulwama108 | 479631 13 | 75 9 | 474771 4 | 4785 |
DistrictCases Chamba29 Hamirpur117 Kangra105 Sirmaur11 Solan32 Una41 Bilaspur21 Kinnaur2 Kullu4 Lahaul And Spiti0 Mandi21 Shimla10 | 313431 15 | 415 5 | 308800 9 | 4216 1 |
DistrictCases Jalandhar297 Ludhiana293 Patiala132 Amritsar485 Barnala25 Faridkot74 Firozepur50 Gurdaspur154 Hoshiarpur140 Kapurthala44 Mansa31 Moga65 Pathankot86 S.A.S Nagar137 Sangrur107 Shahid Bhagat Singh Nagar (Nawanshahr)99 Sri Muktsar Sahib71 Tarn Taran163 Bathinda60 Fatehgarh Sahib57 Fazilka53 Rupnagar (Ropar)74 | 784726 28 | 123 14 | 765314 14 | 19289 |
DistrictCases Haridwar94 Dehradun370 Nainital323 Almora71 Bageshwar31 Chamoli36 Champawat45 PauriGarhwal36 Pithoragarh43 Rudraprayag30 Tehri Garhwal110 Udam Singh Nagar83 Uttar Kashi24 | 449568 | 22 | 441791 | 7755 |
DistrictCases Bishnupur7 Chandel5 Churachandpur32 Imphal East10 Imphal West21 Jiribam3 Kakching2 Kamjong5 Kangpokpi26 Noney1 Pherzawl3 Senapati6 Tamenglong2 Tengnoupal9 Thoubal18 Ukhrul4 | 139924 | 0 | 137775 | 2149 |
DistrictCases Chandigarh313 | 99423 5 | 32 1 | 98208 3 | 1183 1 |
DistrictCases East Khasi Hills22 East Garo Hills0 East Jaintia Hills0 North Garo Hills1 Ribhoi0 South Garo Hills0 South West Garo Hills4 South West Khasi Hills0 West Garo Hills5 West Jaintia Hills1 West Khasi Hills1 | 96791 | 3 | 95163 | 1625 |
DistrictCases Aizawl10 Champhai0 Hnahthial0 Khawzawl0 Kolasib11 Lawngtlai2 Lunglei2 Mamit8 Saiha0 Saitual1 Serchhip0 | 238969 | 0 | 238243 | 726 |
DistrictCases Lakshadweep District0 | 11415 | 0 | 11363 | 52 |
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)