The Occurrence of Hyperactivated Platelets and Fibrinaloid Microclots in ME/CFS, 2022, Nunes, Pretorius et al

Reviewer 2, Jose Alegre-Martin (who heads a CFS clinic in Barcelona, Spain), was kind, to say the least:

And so was reviewer 1, Lily Chu, who is vice-president of the IACFS/ME — she mostly asked for clarifications and adding a part on the strengths and limitations of the study.

Unfortunately, even though the paper was published in a special issue dubbed “Issue Anticoagulants and Antiplatelet Drugs”, neither reviewer commented on the technical aspects of the assay or on the pathophysiological hypothesis proposed by the authors. Peer review, of which there was only one round, essentially amounted to a free pass.

https://www.mdpi.com/1424-8247/15/8/931/review_report

 

Merged thread

Chronic Fatigue Syndrome may be caused by mini blood clots

https://www.newscientist.com/articl...e-syndrome-may-be-caused-by-mini-blood-clots/

New Scientist

29 July
By Grace Wade

Chronic fatigue syndrome may be caused by mini blood clots

Microclots that block blood and oxygen flow are a possible explanation for long covid symptoms like exhaustion and brain fog. Now it seems they may be to blame for chronic fatigue syndrome too


[Stock image of youngish male in denim shirt yawning in front of laptop in industrial style office space.]

[Caption] Persistent exhaustion is characteristic of chronic fatigue syndrome

[Image credit] LightField Studios Inc./Alamy


People with chronic fatigue syndrome may have tiny clots in their blood. These “microclots” could be to blame for the main symptoms of the condition, which include persistent exhaustion, pain and brain fog.

It is estimated that chronic fatigue syndrome, also known as myalgic encephalomyelitis, affects up to 2.5 million people in the US alone, but little is understood about what causes it or how to treat it.

Microclots are clumps of blood platelets under 200 micrometres in diameter that are difficult to break …

[Link is for Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. https://www.ncbi.nlm.nih.gov/books/NBK284905/ ]

------------------

I don't have access to full article.

 

Was just coming to post this, you beat me to it

Paper here: https://www.mdpi.com/1424-8247/15/8/931

 

I'm a subscriber but it's paywalled so I'll share the rough gist of the NS article:

• 25 patients compared to 15 controls. Blood samples analysed for 'seven parameters of abnormal blood clotting, such as clot size and clotting rate'.
• 20/25 patients had at least one abnormality, 4 had five abnormalities.
• Samples reviewed under a microscope for size and number of microclots, graded from 1 to 4. 80% of patient samples scored 2+, 'nearly half' scored 3+. All controls scored a 1.
• Microclots are found in other conditions such as diabetes, Alzheimer's and rheumatoid arthritis. Other studies have found very high levels in Long COVID patients.
  
• Supportive quote from Ian Lipkin. Also some notes of caution:

My own view (not read the full paper yet): interesting study, needs independent validation and, most importantly IMV, sedentary controls.

 

Thanks for posting the link for the paper, Londinium, and the gist of the article, for which I don't have access.

Edited to add: Thanks, also, cassava7, for posting a link to the S4ME discussion thread on the paper.

 

Wrong thread, I know, but I'll drop this here for now. As an aside to the media's use of stock images, I see that

https://ageing-better.org.uk/news/age-positive-image-library-launched

"[Age Positive have] created the first free library showing positive and realistic images of over 50s in a bid to challenge negative and stereotypical views of older age. The photos show a more realistic depiction of ageing – to help tackle ageism and challenge the idea that all older people are frail and vulnerable. The library, which contains over 1,800 images and is regularly updated, offers journalists, organisations and individuals a wide selection of images.

Photos in the library are free for use across your presentations and websites, and they cover themes related to ageing such as health, homes and employment. You can access a preview of our image library below. You can also download our simple guide to using the image library and guidance around commissioning age-positive images.

Guide and terms to using our image library
Download
View all images

 

I contacted the author over Twitter and the image has been updated. It's not the best, but it's definitely better!

 

Blog by John Duncan:
“New Study Finds Microclots In ME*; A Potential Treatment Target?”
https://www.meprecisely.com/2022/07/28/new-study-finds-microclots-in-me/

 

This week I’ve decided to switch to aspirin (rather than ibuprofen or paracetamol) as OTC pain relief because of thinking about this and the long covid equivalent study. Does this seem like a reasonable tweak? I don’t mean I’m taking it everyday regardless, but at the times I’d normally reach for ibuprofen/paracetamol I’m now trying aspirin instead (and actually I need painkillers most days).

I haven’t read the full thread but this study makes me think about the times it’s difficult to get blood out of me for the test, only to be told my blood test is normal. Also comments from ME researchers that our sticky blood is hard to work with and the OMF research indications that there’s something in the blood.
https://mecfsresearchreview.me/2019/04/25/something-in-the-blood/

https://www.healthrising.org/blog/2...ts-chronic-fatigue-syndrome-and-fibromyalgia/

 

I wouldn't change because of the clot story, which remains speculative.
The pros and cons of painkillers are complicated but aspirin as far as I know remains a reasonable choice. It encourages bleeding but is nothing like as troublesome as indomethacin or naproxen. It helps prevent stroke. You only need a tiny dose to do that but a bigger dose works fine. It is likely to reduce risk of vein thrombosis a bit and maybe even heart attacks. The main downside of aspirin is that if you take the maximum dose you start getting tinnitus and metabolic shifts, but it is easy enough to steer clear of that (12 a day). Men can also get gout but only if already susceptible.

Ibuprofen is slightly anti-clot rather than pro-clot and is the safest option I think but aspirin in moderation may have some preventive advantages.

 

yes I’m not going anywhere near that, today I’ve had 1 tablet.

 

I have been using Aspirin pain relief as my initial go to for 20 years. I find 1 tablet to be sufficient where as paracetamol requires two. I also had the sticky blood issue when taking part in the 100,000 project requiring a 4 hour trip for another draw. Not happy

 

It should be noted that non-steroidal anti-inflammatory drugs (NSAID) other than aspirin, such as ibuprofen and naproxen, are associated with an increased risk of heart attacks and strokes. The FDA has warned about this since 2005 and it strengthened its warning in 2015.

On the other hand, aspirin is more likely to cause gastrointestinal complications such as ulcers than other NSAIDs, even at a low dose when used for cardiovascular risk prevention, but this risk can be reduced by taking it with a proton pump inhibitor like omeprazole. (The same applies to other NSAIDs.)

 

I think this has to be carefully worded.
The evidence of increased stroke came from Vioxx and diclofenac and when I last looked seemed to correlate sensibly with Cox2 inhibition. The FDA statement seems to want to cover its back and not discriminate. However, my understanding is that naproxen has been associated with increased bleeding but not stroke as far as I know - consistent with being more towards the aspirin end of the spectrum. I was not aware of convincing evidence for a problem with ibuprofen at standard dosage. That might reflect a relatively incomplete level of Cox blockade at the top of the dose response curve. I am not sure.

I think the evidence probably points to aspirin being more dangerous than ibuprofen over all and I think it would be a mistake to suggest that aspirin is somehow distinct from all the others on the stroke issue. It could of course exacerbate haemorrhage stroke risk.

 

The European Medicines Agency pointed out at the same time as the FDA that the increase in cardiovascular risk was only observed for high-dose ibuprofen (2400 mg/day or greater) but not over-the-counter doses (up to 1200 mg/day).