iDNA against COVID-19
To address the current Covid-19 challenges, the Dutch National Institute for Health and Environment (RIVM) has formally requested Prof. Oudkerk to bring together a group of key opinion leaders and provide an overview of current thrombo-embolic complications related to Covid-19. Members of this expert group included prof. dr. H. R. Büller (Amsterdam University Medical Center), prof. dr. Theresa McLoud (Massachusetts General Hospital) and dr. D. Kuijpers (Haaglanden Medical Center). Prof. Oudkerk is one of the first worldwide experts to link previously unexplained Covid-19 complications to local thrombosis in the lungs. Previously, clinical experts were solely focussing on acute respiratory distress syndrome (ARDS). After publication of the report as guideline of the RIVM, the outcome of this study has now been published in Radiology and was their most viewed article for a time.1
Prof. Oudkerk and his group found strong indications that COVID-19 in most cases does not result in pneumonia, but in a thrombosis related disease. It is stipulated that the virus causes systemic micro thrombosis, of which the symptoms first arise in the lungs. When this clotting grows to macro thrombosis, embolic processes occur in the lungs, subsequently spreading to other organs, causing the range of complications currently observed in COVID-19.
At the time of publication (April 23rd), this view of COVID-19 was a worldwide unprecedented idea. As a result, more and more additional evidence is piling up, stating the thrombo-inflammatory process is indeed the main complication of SAR-CoV-2.2-4 This is reflected in alterations in the treatment protocol for COVID-19, which is now focussing on a more (preventive) anticoagulant therapy, potentially circumventing many unnecessary complications and potentially saving numerous lives worldwide.
- Oudkerk M et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology. 2020 Apr 23:201629. doi: 10.1148/radiol.2020201629. [Epub ahead of print]
- Paranjpe I, Fuster V, Lala A, Russak A, Glicksberg BS, Levin MA, Charney AW, Narula J, Fayad ZA, Bagiella E, Zhao S, Nadkarni GN. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. Journal of the American College of Cardiology, 2020; DOI: 10.1016/j.jacc.2020.05.001
- Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19 [published online ahead of print, 2020 Apr 10]. Thromb Res. 2020;S0049-3848(20)30120-1. doi:10.1016/j.thromres.2020.04.013
- Wichmann D, Sperhake J, Lütgehetmann M, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020; [Epub ahead of print 6 May 2020]. doi: https://doi.org/10.7326/M20-2003