Covid: who risks thrombosis, more serious forms in those who smoke, what will happen in

from Laura Della EasterLaura Della Easter

1. Who is healed at risk of thrombosis?

2. Does smoking aggravate the disease?

3. Towards the end of the pandemic or a new wave in the fall?

Thrombosis: symptoms and prevention

1. Who is healed at risk of thrombosis?

About two years after its appearance, the first results of the post-COVID-19 follow-up studies begin to arrive. Among the most complete is the one published on The Lancet Respiratory Medicine conducted on 1192 patients in China affected by Covid during the first phase of the pandemic, of which 68% showed six months after becoming ill at least one symptom of long Covid. Among the various effects of Covid, after healing, those symptoms known as Long Covid, there is also the risk of thrombosis. Who does it strike and which therapy to face to be safe? We forwarded the question to the head of the Vascular Surgery Unit of Humanitas Gavazzeni, Giovanni Esposito who explored this issue.

The disease, in the most serious cases, can trigger a strong inflammatory response, capable of giving rise to thrombosis phenomena. These, in addition to representing a risk in the acute phase of the infection, can over time leave their mark on the affected organs. A similar aspect, combined with a possible autoimmune reaction induced by the virus, is among the main suspects behind the Long-Covid. The Gavazzeni scholar emphasizes that “the alterations of the coagulation system also influence the ability of platelets to aggregate and therefore facilitate the onset of thrombosis or, more rarely, of haemorrhages”.


How long after healing are you at risk?

Recent studies published in the scientific journal Blood Advances It is on British Medical Journal show how Covid-19 increases the risk of deep vein thrombosis up to three months after the end of the disease, of pulmonary embolism in the six months post-Covid and of haemorrhagic events in the two months following the negative test.


What symptoms should we watch out for?

For patients recovered from Covid-19 as well as for any other patient it is very important to report every symptom to your doctor. Pay particular attention to the appearance of swelling of a limb (edema), pain, redness and increased temperature of the affected area. Breathing difficulties, shortness of breath, chest pains can be signs of a more complicated picture.


Is there a risk even with mild Covid?

Scientific studies show that thromboembolic events are more frequent in elderly, pluripathological people, especially those affected in the first wave when vaccination coverage was low and therapies not yet perfected. The risk of thrombosis in people who had been seriously ill with Covid was 290 times higher than normal and seven times higher than normal after mild Covid.


What therapies?

There are currently numerous scientific studies that seem to support the usefulness of thromboprophylaxis to avoid thrombotic events, especially for high-risk patients, and certainly reinforce the importance of vaccination. We still have to wait for the results of the studies on the effects of long Covid on the various organs in order to be able to use preventive treatment on a large scale.


Can there be relapses?

As with all thromboembolic diseases, whether it is post Covid syndrome or deep vein thrombosis due to other causes, a relapse is possible. We do not yet know if the risk of recurrence of a thromboembolic disease is greater in post Covid. We are faced with a “young” pathology about which we still know little.

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2. Does smoking aggravate the disease?

“Smoking causes the development of more severe forms of Coronavirus infection.” This is what is stated by the Head of the Laboratory of Epidemiology of Lifestyles, of the IRCCS Mario Negri, Silvano Gallus, which was commissioned by the WHO to study the relationship between Covid and smoking. “Smokers, like ex smokers, have a 30 to 50% higher risk than others of having severe Covid or dying. A good portion of the 6.2 million deaths from the virus are attributable to smoking. After Covid, an increase in tobacco consumption was detected, ”says Gallus.

Studies carried out in collaboration with the Prevention and Research Institute (ISPRO), the Tobacco Free Research Institute Ireland, and the Català Oncology Institute, have shown that smoking is associated with an increased risk of developing acute respiratory distress syndrome. . A study conducted on 1099 patients has documented that those with severe symptoms, at the time of hospitalization, 31.7% declared themselves to be smokers and 14.5% non-smokers. In addition, among those who needed ICU admission and use of mechanical ventilation, or died, 16.2% were smokers and 4.7% were not. In another study involving 78 patients with Covid-19 pneumonia, it was found that 27.3% of infected smokers showed no improvement after 2 weeks, compared with 3% of those who never smoked. Therefore, among the various risk factors for avoiding a more severe prognosis of Covid-19, smoking appears to be the most important, although it may not be directly related to the incidence of the disease caused by the virus.

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3. Towards the end of the pandemic or a new wave in the fall?

Are we at the last blows of the virus or is it just a temporary stop favored by the summer heat and the longer time spent by people in open places? Experts are divided between those who argue that in the autumn there will be a resumption of the expansion of Covid, determined above all by the variants (in the United States 100 million infected are expected for the autumn) and those who believe that the virulent load is being lost and the virus will become a part of respiratory diseases every winter, like the flu. We turned the question over to the geneticist Paolo Gasparinipresident of the Society of Genetics who is very cautious in forecasting.


It’s hard to say if we’re at the last stages of the pandemic, at that stage of the evolutionary cycle, but it would surprise me if we went back. The number of naturally immune and vaccinated individuals is growing, but at the same time the variants are highly contagious. We need to think in a global and international context. There continue to be reservoirs of populations in the world, poorly vaccinated, and variants can develop there and spread throughout the world.


Will the abolition of restrictions, up to the mask, lead to an increase in infections?

England has long since removed the containment systems and has no more serious picture than ours. The Croatians have been without restrictions for months and have not had a worse situation, perhaps because there are several factors at the same time, environmental and linked to the immunity of the individual. It is clear if you look at the history of pandemics after a while the population becomes more resilient and the virus adapts. Over the years there is this sort of adjustment.

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