Michael Makris @ProfMakris Twitter profile

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Michael Makris

@ProfMakris

3 years

Amazing case report. The medicine of tomorrow. 5 week old boy admitted to NICU. Within 37 hours he had his whole genome sequenced, gene defect identified, treatment ordered and received by patient. Within 6 hr symptoms resolved.

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Michael Makris

@ProfMakris

4 years

This is from today's New York Times about the first lung transplant in the US for COVID-19 lung damage. For me the amazing feature is the lung pathology. This was a previously healthy woman in her 20s with no comorbidities who developed COVID-19!

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Michael Makris

@ProfMakris

3 years

Succinct one page editorial on long covid in this week's issue of @TheLancet . 945,000 persons in the UK are suffering from Long Covid including 34,000 children aged 2-16 years. #COVID19

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Michael Makris

@ProfMakris

3 years

The remarkable results of the efficacy of the Pfizer #COVID19 vaccine in the 5-11 year olds have just been published by the New England Journal of Medicine @NEJM . It works really well and is safe.

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Michael Makris

@ProfMakris

3 years

The decision by @BorisJohnson to lift all restrictions will be a big problem for the immunocompromised who do not mount good responses to the vaccines? How can they go on public transport or do their food shopping safely?

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Michael Makris

@ProfMakris

5 months

Great profile of Peter Hotez in @TheLancet this week. If you have read his book on "The deadly rise of anti-science" you will realise why The Lancet chose him for a Profile piece. @PeterHotez

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Michael Makris

@ProfMakris

3 years

Israeli study shows that although the level of antibodies against #COVID19 are higher after vaccination than infection, they fall a lot faster (40% vs 5% drop per month).

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Michael Makris

@ProfMakris

4 years

Pulmonary Intravascular Coagulation (PIC) as opposed to DIC proposed as the basic process in the pathogenesis of COVID-19. Well argued with beautiful diagrams.

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Michael Makris

@ProfMakris

4 years

Interesting point made by Fiona Bruce on Question Time. At the daily government press conferences when the UK death data were lower than other European Countries no mention of accuracy of comparisons was made. Now that we are higher, warnings about comparisons is constant.

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Michael Makris

@ProfMakris

3 years

Paper in the BMJ about which patients get hospitalised and die despite full vaccination against #COVID19 . This table shows the risk of death. Factors include care home residents, those with cirrhosis, renal failure, Sickle cell, HIV and having chemotherapy

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Michael Makris

@ProfMakris

3 years

Details of the first 2 autopsies of persons dying from VITT have been published from Italy. The venous thrombosis was more widespread than diagnosed in life. Also microvascular damage in multiple organs. #VITT #COVID19

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Michael Makris

@ProfMakris

5 months

Intresting short article in @NatureMedicine discussing the decline in clinical academics in the UK and US. Another issue, not discussed, is the failure to recognise all the components of the job equally, clinical/research/teaching. The interests of Universities and the NHS are

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Michael Makris

@ProfMakris

2 years

People who think infection with #COVID19 will protect them from further COVID-19 infection should think again. This paper from South Africa shows persons reinfected with COVID-19 (PCR proven) up to 4 times.

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Michael Makris

@ProfMakris

4 years

The best paper so far on COVID-19 in children. 171 infected children: 16% asymptomatic, 65% pneumonia, 3 ventilated, 1 death in 10 month old child with intussusception. Not as benign as people suggest.

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Michael Makris

@ProfMakris

3 years

I was surprised to learn that some people think I am against #COVID19 vaccination. This could not be further from the truth. I believe virtually everybody in the world aged 12+ should be vaccinated against COVID-19. Asking for transparency does not mean I am against vaccinations.

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Michael Makris

@ProfMakris

1 year

Monoclonal Gammopathy of Thrombotic/Thrombocytopenic Significance will be a new term for most of us. Paper in press in @BloodJournal . If you have a patient with a monoclone, thrombosis and thrombocytopenia, test them for anti-PF4 using an ELISA assay.

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Michael Makris

@ProfMakris

2 years

After 33 years, I am retiring from the University of Sheffield today. It has been an amazing journey and I am so glad to have worked here. I will be returning to do the clinical part of my job which will be unchanged.

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Michael Makris

@ProfMakris

3 years

UK study shows that if a vaccinated person is PCR #COVID19 positive, the risk of transmitting the infection to household contacts is halved (compared to if they were not vaccinated). Similar results for both AZ and Pfizer. Paper in tomorrow's @NEJM .

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Michael Makris

@ProfMakris

4 years

In an autopsy series of COVID-19 patients from France the authors report that what they are seeing is acute fibrinous and organising pneumonia characterised by extensive intra-alveolar fibrin deposition rather than hyaline membranes.

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Michael Makris

@ProfMakris

3 years

Our paper describing 220 cases of definite and probable cases of Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT) following AZ vaccination has just been published by the New England Journal of Medicine.

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Michael Makris

@ProfMakris

4 months

The UK has today declared a national incident due to the outbreak of cases of measles. Measles is much more infectious than COVID-19 (R values of 15 vs 3). Campaigning against vaccination has consequences.

Get measles vaccine to avoid rapid spread, says UK health boss

People have forgotten how miserable it is to have measles, a top health official warns.

www.bbc.co.uk

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Michael Makris

@ProfMakris

3 years

The number of VITT cases in the UK (all post AZ vaccination) reported to the MHRA has been updated today. Now we have 262 cases with 19.5% mortality. 254 after 1st dose and 8 after 2nd dose.

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Michael Makris

@ProfMakris

3 years

Preprint paper suggests that inadvertent intravenous injection of the AZ vaccine is what is (at least partially) responsible for VITT. They suggest aspiration before injection of the AZ vaccine could limit the risk of VITT.

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Michael Makris

@ProfMakris

4 years

Good practical guidance on COVID-19 and coagulation. 1. Use LMWH prophylaxis, 2. Consider PE in deteriorating patient, 3. Do not correct the coagulopathy in the non-bleeding patients, and 4. Do not use tranexamic acid in COVID-19 associated DIC.

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Michael Makris

@ProfMakris

2 years

Pregnant women who were vaccinated against #COVID19 had a lower risk of pre-term labour, stillbirth or congenital abnormalities in the babies, compared to the unvaccinated women. #pregnancy #vaccination

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Michael Makris

@ProfMakris

2 years

This is the Death Certificate for the Queen. Interesting cause of death, considering the image on the right was two days earlier. #Queen

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Michael Makris

@ProfMakris

3 years

Is it not odd that the government and news agencies accept 30,000-40,000 new #COVID19 cases per day in the UK with no mention that in Germany, Italy, France and Spain is less than 5,000. Is it a reflection that the UK has abandoned masks and social distancing?

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Michael Makris

@ProfMakris

2 years

Brilliant. This is the best book on #COVID19 and its international management that I have come across. In my opinion, Professor @devisridhar has consistently been the best communicator of COVID related information in the UK.

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Michael Makris

@ProfMakris

4 years

Congratulations to Alex Dowsett who won the 8th stage of the Giro d'Italia today. As a #haemophilia treater I find it incredible that a person with severe #hemophilia A can achieve something like this.

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Michael Makris

@ProfMakris

2 years

Microclots as a cause of long covid is one of several hypotheses proposed. I believe long covid is real. I also believe that something is detected in the blood using the Resia Pretorius assay. I am not convinced that what is detected in the Pretorius assay causes long covid. 1/n

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Michael Makris

@ProfMakris

4 years

New guidance document published by a group of ISTH authors on the diagnosis and management of COVID-19 coagulopathy. All doctors should read this. Utilisation of DDimer in decision making at diagnosis and during disease progression will be important.

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Michael Makris

@ProfMakris

3 years

Important. A case of VITT 10 days after 2nd Moderna vaccination. Severe thrombocytopenia, cerebral vein thrombosis, PE, bilateral DVT, high D-Dimer, anti-PF4 of 2.9. This looks like typical VITT.

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Michael Makris

@ProfMakris

2 years

After 2 years it was great to see my mother in Cyprus, who is 92 years old and recovering from COVID, in person. I thought I should get some names to draw a family tree. Over about 1 hour she gave me 97 names spanning 7 generations and going back to 1878 - all from memory!

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Michael Makris

@ProfMakris

1 year

In patients with orthopedic trauma, aspirin is not inferior to low molecular weight heparin in preventing venous thrombosis.

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Michael Makris

@ProfMakris

3 years

Heterologous prime boost #COVID19 vaccination with AZ followed by Pfizer is superior to 2 doses of AZ or 2 doses of Pfizer.

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Michael Makris

@ProfMakris

3 years

The German concern is about 7 cases of cerebral vein thrombosis (CVT) and thrombocytopenia in 1.6m AZ-Oxford vaccinated persons. In UK 3 episodes of CVT in 11m AZ-Oxford vaccinated. Baseline risk is 2-5 per million per year acc to German Health Ministry. #COVID19

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Michael Makris

@ProfMakris

3 years

The first paper on the #COVID19 vaccine associated thrombosis/thrombocytopenia issue has just been published from the German GTH group. Very valuable initial experience. #thrombosis

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Michael Makris

@ProfMakris

3 years

Deja vu. It's Thursday, the MHRA release the AZ vaccine safety data, the VITT case number is now 242 and still no data on the rate of VITT by age. As VITT is strongly age related it's not acceptable to just give the overall rate which is now 1 in 95,000

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Michael Makris

@ProfMakris

2 years

Impressive graph from Our World In Data on the #COVID19 related deaths among vaccinated and unvaccinated individuals in the US. How intelligent people can look at this and refuse vaccination is beyond me.

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Michael Makris

@ProfMakris

2 years

It was a surprise to wake up to the national news on BBC Radio 4 this morning and find out that one of the main news stories was our paper on Gene Therapy in #Hemophilia B. I knew it was accepted by @NEJM , but did not realise it was being published today.

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Michael Makris

@ProfMakris

3 years

If patients who has a 1st AZ vaccine receive Pfizer as their second vaccine, they achieve a good immune response with only relatively low adverse events (reactogenicity). Randomised trial from Spain in @TheLancet .

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Michael Makris

@ProfMakris

4 years

How sad to hear that Takuo Aoyagi, the inventor of the pulse oxymeter died of COVID-19. The number of persons he has helped over the years must be enormous.

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Michael Makris

@ProfMakris

2 years

If you ever request INR or APTT, this is for you. An one page summary of the key points published today by the @CMAJ . Although the authors are Canadian, the points made apply internationally.

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Michael Makris

@ProfMakris

4 years

A total of 34 leaflets and newspapers were left in an #ASH19 bag outside my hotel room on the first official day of ASH. All went into the bin unread. Poor trees. Can we have an opt-out of getting all this ⁦ @ASH_hematology ⁩ ?

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Michael Makris

@ProfMakris

5 months

Today is officially the first day of my new job as Editor-in-Chief of the journal Research and Practice in Thrombosis and Haemostasis. A huge thanks to @MaryCushmanMD and her team of amazing associate editors for getting the journal from its launch to its current position.

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Michael Makris

@ProfMakris

4 years

Today has been the most important day in terms of high quality publications on COVID-19. Up to now amazingly 15425 manuscripts have been published in scientific journals. However 4 of the top 10 papers ever published on COVID-19 were published today. #COVID ー19 #Coronavirus 1/5

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Michael Makris

@ProfMakris

4 years

This is probably a coincidence, but is it not interesting that countries led by women (Denmark, Finland, Norway, Iceland, Germany and New Zealand) have lower death rates from COVID-19 than their neighbours which are led by men?

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Michael Makris

@ProfMakris

2 years

If you are looking for a review article for an update on the management of Immune Thrombocytopenia (ITP), this is excellent and very practical. The PDF is free.

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Michael Makris

@ProfMakris

3 years

I am pro-vaccine and especially so when it comes to #COVID19 . I have participated in the vaccine clinical trial and will do so again. I have had AZ x2. I believe people should be provided with all the available information to allow them to make a decision before vaccination. 1/4

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Michael Makris

@ProfMakris

3 years

Article in today's @TheLancet shows that vaccination with the AZ vaccine has no impact on fertility of outcome of pregnancy. #pregnancy #COVID19

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Michael Makris

@ProfMakris

3 years

Although I tweet tables of adverse events after #COVID19 vaccination, I am NOT against vaccination. I strongly believe that every person in the world over the age of 12 should be vaccinated against COVID-19. I tweet so that people can make an informed choice on vaccine type.

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Michael Makris

@ProfMakris

4 years

Great painting by Banksy. Such a powerful image at so many levels.

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Michael Makris

@ProfMakris

3 years

Another paper, this time from the UK, published on line by @NEJM on Vaccine-induced Immune Thrombosis with Thrombocytopenia (VITT). The paper describes 23 cases after AZ vaccination and provides a management algorithm.

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Michael Makris

@ProfMakris

3 years

Our short review on Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT) has now been published as a free PDF in the @RPTHjournal . #VITT #COVID19

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Michael Makris

@ProfMakris

2 years

I was sad to hear of the death of Olivia Newton-John, an incredibly talented singer and actress. I wonder how many people know that Gustav Born, who developed platelet aggregometry was her uncle and Max Born who won the 1954 Nobel Prize for Physics was her grandfather.

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Michael Makris

@ProfMakris

3 years

Great practical talk on DOAC management form Jan Beyer-Westendorf. Dose adjustment if required for renal impairment and frailty. Very good clear diagrams.

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Michael Makris

@ProfMakris

4 years

The bleeding in acquired haemophilia does not correlate well to the FVIII level or to the titre of the autoantibody. The bruising once seen, is never forgotten. Hematologists should be able to make the diagnosis by looking at the patient for a few seconds.

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Michael Makris

@ProfMakris

6 months

For special interest to UK readers, this book explains how lying, self interests and incompetence over the last 10 years led to the decline of the UK that we all experience today. The rise and fall of Boris Johnson and Jeremy Corbyn are clearly explained. @mrjamesob

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Michael Makris

@ProfMakris

3 years

Study from England shows that if you have had your first #COVID19 vaccine (Pfizer or AZ) and get COVID-19 infection, you are only 50% as likely to transmit the infection to your household compared to unvaccinated infected persons.

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Michael Makris

@ProfMakris

3 years

Our paper on Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT) has just been published on online early by @RPTHjournal . For an update on the subject have a quick look. #VITT #COVID19

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Michael Makris

@ProfMakris

3 years

So the UK VITT incidence after 1st AZ vaccination is now 1 in 74,500. This is 8x higher than it was 10 weeks ago. This is misleading because VITT is strongly age related. We need the number of persons who have received the 1st AZ vaccine by decade of age so we can work out rates.

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Michael Makris

@ProfMakris

2 years

Having avoided #COVID19 for the last two years, it has finally arrived. There is so much of it around the UK at present. I am not too bad so far.

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Michael Makris

@ProfMakris

3 years

Our paper on Vaccine-induced Immune Thrombocytopenia and Thrombosis #VITT is in the print issue of the New England Journal of Medicine @NEJM this week. 1/4

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Michael Makris

@ProfMakris

3 years

This is a brilliant unrolled twitter thread from an Australian ICU Dr. Once you have read it you will realise why our aim should be "zero covid" rather than "living with covid". If we want quality secondary healthcare in all areas, zero covid should be the target. #COVID19

Thread Reader App

@threadreaderapp

3 years

@wokabaut_meri Bonjour, please find the unroll here: I think much of the incoherence & backflips in #COVID19 response, esp… See you soon. 🤖

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Michael Makris

@ProfMakris

4 years

Paper just published in JTH. The use of heparin is associated with improved survival in patients withCOVID-19 and very high DDimer. Prophylactic LMWH doses. Non randomised study. The prothrombotic potential of COVID-19 is gaining momentum in importance.

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Michael Makris

@ProfMakris

11 months

The most impactful presentation at #ISTH2023 (in my opinion) was given by Rucha Patil from Mumbai in India. In a small study with short follow-up she described the effective use of low dose emicizumab and found it as effective as full dose. They actually used half dose emi.

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Michael Makris

@ProfMakris

3 years

This is the age breakdown of the AZ Vaccine-Induced Immune Thrombocytopenia and Thrombosis (VITT) cases in the UK, updated today by the MHRA. 272 cases of which 66 were fatal. The authorities are still not making public the data on how many in each age group have had AZ vaccine.

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Michael Makris

@ProfMakris

3 years

This is the most up to date, readable, beautifully illustrated non-VITT #COVID19 and thrombosis review I have seen. It has just been published by the Lancet. I expect you will see these illustrations again if you attend a COVID-19 thrombosis lecture!

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Michael Makris

@ProfMakris

6 years

One tablet of ferrous sulphate every other day results in higher iron absorption that two tablets daily. Elegant study that will be practice changing. #irondeficiency #anemia

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Michael Makris

@ProfMakris

4 years

If figure 1 does not impress you, nothing will. These are the updated data from the Klok study in the Netherlands. 184 ICU patients with COVID-19, all on LMWH prophylaxis. Thrombosis rate 49% with 65 pulmonary emboli.

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Michael Makris

@ProfMakris

4 months

Very good review on the diagnosis and treatment of iron deficiency recently accepted by the @BrJHaem . Lots of practical information that anybody that prescribes iron will find useful. #iron #irondeficiency

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Michael Makris

@ProfMakris

2 years

When I first saw this photo I thought it was a staged joke on American culture. Amazingly it turns out this is real and it is the family of a US congressman. I expect it will be difficult for US citizens to realize how odd this looks to the non-US world.

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Michael Makris

@ProfMakris

3 years

Anti-PF4 antibodies detected with in-house ELISA in 5.5% post Pfizer and 8.0% post AZ vaccination. 18/19 +ve samples had OD <1.0 and 1 >2.0. None activated platelets. 11/19 pre-vaccination samples available and 7 were +ve. Greinacher group paper in Blood.

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Michael Makris

@ProfMakris

3 years

IMPORTANT. Convalescent plasma is of no benefit in #COVID19 . 10,406 patient RCT as part of RECOVERY platform. 1873 deaths. 28 day mortality in plasma group 18% and in standard of care group 18%. Very disappointing but shows the value of large RCTs. @EricTopol @DrEricDing

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Michael Makris

@ProfMakris

1 year

I enjoyed reading this article about a UK doctor who went to Australia and is coming back. The UK NHS can learn so much about how to treat and retain its doctors. This is in the @bmj_latest journal this week.

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Michael Makris

@ProfMakris

3 years

I was asked whether VITT was serious. Yes it is, in the typical VITT cases. The official MHRA data indicates a mortality rate of 20%, but this is not the whole story because it does not say how many of the remaining 80% are still in hospital or have life changing morbidity.

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Michael Makris

@ProfMakris

3 years

New UK data released today on Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT) after #COVID19 vaccination. According to the UK regulator the MHRA, there are now 348 cases of VITT in the UK of which 330 are after 1st AZ dose and 18 are after 2nd AZ dose.

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Michael Makris

@ProfMakris

11 months

Despite the label there is no increase in risk of thrombosis with tranexamic acid. Michelle Sholzberg lecture at #isth2023

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Michael Makris

@ProfMakris

3 years

Dear MHRA, You have a moral obligation to the people of the world to reveal the rate of VITT after 1st AZ vaccination by decade of age. There is a strong age relation. To say as you do that it is 1 in 92500 for >50 years and 1 in 49000 for <50 years is not good enough. 1/2

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Michael Makris

@ProfMakris

2 years

I am back on Twitter. Twitter blocked my account for "Spreading misleading and potentially harmful information about COVID19". Judge for yourselves if the relevant tweet is so bad. 1/3

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Michael Makris

@ProfMakris

4 years

The Italians have received approval for a randomised trial of standard LMWH thromboprophylaxis vs full dose in patients with COVID-19. This is an important study that needs to be done.

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Michael Makris

@ProfMakris

1 year

Aspirin is inferior to low molecular weight heparin in preventing venous thrombosis after hip and knee arthroplasty. This result is in contrast to the NEJM paper last week showing non-inferiority for aspirin in lower limb trauma. #aspirin #thrombosis

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Michael Makris

@ProfMakris

3 years

The UK MHRA data released today covers analysed data up to 5th May 2021. The incidence is getting more frequent every week. Overall the VITT incidence in the UK post AZ vaccination is 1 in 92,000. However I have been told today that for those <50 years the rate is 1 in 50,000.

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Michael Makris

@ProfMakris

11 months

The risk of DOAC related bleeding in patients with cirrhosis is no higher than with other anticoagulants (and may be lower). Meta-analysis of 29 studies which included 2469 patients with cirrhosis receiving DOAC anticoagulation. #thrombosis #DOAC

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Michael Makris

@ProfMakris

3 years

The Israeli authorities are reporting an 1 in 50,000 risk of myocarditis after Pfizer #COVID19 vaccination. 90% of cases are in young men. This is 5-25x higher than the background rate.

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Michael Makris

@ProfMakris

4 years

Important paper in the Lancet alerting clinicians to secondary Haemophagocytic Lymphohistiocytosis (sHLH) in advanced COVID-19 and the need for steroids and immunosuppression when it occurs. The high ferritin is key in pointing to this.

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Michael Makris

@ProfMakris

3 years

Do not test patients with retinal vein or artery occlusion for thrombophilia. Comprehensive meta-analysis of 95 studies.

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Michael Makris

@ProfMakris

4 years

This is the most beautiful infographic I have come across on COVID-19. It makes you realise that delivery of information is really an art. It can be downloaded freely at . @azuravesta

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Michael Makris

@ProfMakris

3 years

A very good document on #COVID19 vaccines and blood clots has been posted on the UK Parliament website this evening. It is a serious, accurate, easy to read, up to date document. It was written by the Parliamentary Office of Science and Technology.

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Michael Makris

@ProfMakris

3 years

The UK regulator the MHRA has released updated data on #VITT after the AstraZeneca vaccine. The number of cases is now 209 up from 168 a week earlier. They now give a breakdown by age. Thats a start. They need to give breakdown by decade of age and sex.

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Michael Makris

@ProfMakris

4 years

Interesting letter from Cattaneo et al. They argue that what we see are pulmonary thrombi rather than pulmonary emboli. They suggest that these thrombi are the hallmark of severe COVID-19 and are responsible for the ischaemic clinical manifestations.

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Michael Makris

@ProfMakris

3 years

Important paper showing that the ferritin level cut-off for women (15micrograms/L) recommended by the WHO is wrong. Based on US NHANES data they show that the physiologically important cut-off for women is 25 micrograms/L.

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Michael Makris

@ProfMakris

3 years

Well it's Thursday afternoon in the UK! The MHRA have updated their #COVID19 vaccine data. The number of VITT cases has gone up (294 after 1st and 15 after 2nd AZ vaccine). Once again the data on number of persons vaccinated by decade of age are missing. I will keep asking.

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Michael Makris

@ProfMakris

3 years

Data from Australia on risk of VITT by age. Why can the UK not do this with 10x as many persons vaccinated with AZ? Even better, show VITT cases and number AZ vaccinated by decade of age for all age groups and allow us to calculate rate and error bars.

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Michael Makris

@ProfMakris

11 months

Confirmation that bone marrow analysis is not usually required in patients with cytopenias and advanced liver disease. Only 1/118 patients was found to have myelodysplasia to explain the cytopenia.

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Michael Makris

@ProfMakris

11 months

Iron supplements are best absorbed if taken in the morning, away from meals or coffee, and with an ascorbic acid rich food or beverage. #iron

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Michael Makris

@ProfMakris

3 years

The UK authorities have approved Rivaroxaban for use in children from birth to 18 years. This will make anticoagulation in this patient group so much easier.

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Michael Makris

@ProfMakris

4 years

I despair. These are photos from the Bath and Liverpool half marathons which took place today in the UK. What sane government allows these to take place in the middle of an epidemic? Do people not watch the news? Will they not be interacting with their elderly parents later?

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Michael Makris

@ProfMakris

3 years

The UK guideline for Emergency Departments on how to deal with persons presenting with headache after AZ vaccination has been revised. The timing now 42 days. Also platelets can be normal and on the way down in 5% of patients.

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