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SINGAPORE – When Mr Ullah Kefayet was battling Covid-19 in the intensive care unit of the National Center for Infectious Diseases in May, his family thought they had lost him.
“My family thought I was already dead,” he told reporters in a short video chat on Tuesday (October 13).
Connected to a ventilator and in a coma at the time, the 39-year-old delivery driver was unable to communicate with his wife and nine-year-old son in Bangladesh.
Fortunately, that lasted only four days. But it was a rare complication that he developed prior to being admitted to the ICU that took his doctors by surprise. He experienced acute pain in his right foot and developed early gangrene in three toes of that foot.
Doctors discovered that it was due to a thrombus or blood clot in the aorta, the main artery that carries blood from the heart to the rest of the body.
They operated on him quickly, inserting a permanent aortic stent through his groin. Three months later, his gangrene completely dissolved and he was able to walk properly again.
“It’s very rare for a blood clot to develop in the aorta, which is a high-flow blood vessel,” said adjunct assistant professor Glenn Tan, chief of general surgery and senior consultant at Tan Tock Seng Hospital (TTSH).
It was even more surprising since Kefayet, who was admitted for shortness of breath and fever, did not have any underlying illness, Professor Tan said at a news conference Tuesday.
Studies have shown that there is a high risk of seriously ill Covid-19 patients developing sticky blood and blood clots that can lead to strokes, heart attacks, and other life-threatening complications.
This is just one of many ways that Covid-19, initially viewed as a seemingly simple respiratory disease, can harm the body.
But it is not clear why some Covid-19 patients have blood clots.
Professor Tan said that a probable cause is that Covid-19 causes severe inflammation in some patients. This increases the production of cytokines (proteins made by immune cells), which can lead to blood clots.
Another cause could be some damage to the blood vessel wall that results in an increased risk of clot formation, he said, adding that it is not common to see Covid-19 patients here developing blood clots, possibly because most of they are relatively young and healthy. .
He and other experts, including Adjunct Associate Professor Pua Uei, Senior Consultant in TTSH’s Department of Diagnostic (Clinical) Radiology, who treated Mr. Kefayet, published a paper on the treatment of arterial blood clots in Covid patients. 19 in the British Journal of Surgery in August.
Professor Tan said: “Some studies showed that some people had recurring blood clots in the legs … and my first suspicion was that there were actually clots in the aorta that were not recognized at the time. It is important to look for the source.
“It is very unusual for young people to have gangrene in the legs when they do not have any other medical problems such as diabetes, so we wanted to see if there were other causes.”
So a scan of Mr. Kefayet’s leg was followed by a scan of his aorta. That’s when doctors found the source of her problem and discovered that the aortic clots were dislodging from her aorta and heading not only to her right leg, but also to her spleen and kidneys. “If we had left the clots alone, they probably would have started to travel to his left leg and his intestinal blood vessels,” Professor Tan said.
Without timely surgery, Kefayet could have lost his toes and possibly his legs.
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