Critical care doctors seeing more blood clotting after COVID-19 acute illness

Published: Oct. 26, 2020 at 8:30 PM CDT
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WAUSAU, Wis. (WSAW) - As hospitals around Wisconsin, including the north-central region, see an increase in the number of patients hospitalized with COVID-19, doctors are beginning to see some commonalities in patients reactions to the disease. Though it is a wide spectrum of reactions, and doctors still have questions.

“It turns their lungs into, like, stiff, wet sponges,” Dr. Kris Lahren described. He is a pulmonary medical doctor at the Aspirus critical care unit in its Wausau hospital. The critical care unit sees the patients with the most severe cases of COVID-19.

“Almost all of them have respiratory failure, so can’t breathe on their own," he explained. "They need breathing tubes and breathing machines. A significant number of them need medicines to maintain their blood pressure. They become hypotensive or have low blood pressure.”

He said a smaller amount of people have kidney failure and need dialysis. He said if a patient is “lucky enough to make it through the acute illness,” they are often left with “profound weakness.”

“A couple of patients right now who I’m taking care of who were conscious, but they could not interact with us at all because they were so weak they could not even open and close their eyes or move their lips,” Dr. Lahren said. “Now, with time they have recovered to where now they’re communicating, they’re following commands and answering questions, but at first we weren’t sure whether or not they could hear us or understood that we were working with them.”

He explained they often have to heavily sedate patients this sick and sometimes use neuromuscular blockades or paralytic drugs so patients do not move and can breathe comfortably on a ventilator.

“We know that that leads to weakness and some and sometimes nerve injuries and muscle injuries and those are very slow to recover,” he said. He added patients who recover from their initial COVID-19 illnesses then sometimes have tracheotomies or breathing tubes in their throat for months.

Dr. Lahren said there are patients who had severe reactions earlier and then come back weeks later with blood clots. He said this has become very common.

“I had a patient who recovered very well from his pneumonia, went home, and then about a week or to 10 days later, developed a pulmonary embolism, had to be readmitted, treated and now he’s doing well, but that’s a pretty common scenario,” Dr. Lahren recalled.

He and Dr. Deb Mojumder, a neurologist in the same unit, are seeing an increase in strokes too.

“Many of them I see have significant risk factors for stroke," Dr. Mojumder stated. "So the question is, is it because of a clotting disorder that is caused by coronavirus, or is it just because of the risk factors?”

While he said that answer is hard to determine right now, he has been seeing some unusual stroke cases in people who have had COVID-19. He said one of his patients who was intubated for a long time was found to have had two strokes in the same area of the brain, which is not typical. He compared it to lightning striking twice in the same area.

"Which kind of suggests there is something unusual going on in the clotting mechanism or maybe the coronavirus is causing some inflammation conditions in the blood vessels,” he suggested.

“Since this is a new disease that nobody knew about 10 months ago, we’re learning every day about what to do for treatment, about what’s the best way to handle these patients," Dr. Lahren said referring to learning about the blood clotting commonality. "We’re learning that we have to anticoagulate (sic) them more aggressively and longer than we would normally do for someone who is critically ill.”

Dr. Mojumder said he also has seen patients with less severe symptoms initially, maybe requiring oxygen, coming in weeks later with a neuromuscular disorder. While all of the other severe reactions to COVID-19 seem to be found in patients who already had high health risk factors before their diagnosis, the development of neuromuscular disorders Dr. Mojumder said he is seeing regardless of preexisting health conditions or age. He said he does not know why this happens.

Dr. Lahren said there are some patients who had less severe reactions initially also come in with persistent respiratory problems “and at this point, we still don’t have anything different or new to do for them.”

There are other reactions doctors say they have not seen here yet, but are expecting to see them in the near future.

“In areas where they’ve already kind of gone through their surge and they’ve had a higher number of patients in big populated areas, they certainly have seen a lot of cardiac problems that are long-term, some respiratory problems that are long-term," Dr. Lahren said. 'We’re sort of just at the beginning of our surge here, so we really haven’t seen that yet, but we very well might.”

“The interesting thing about this virus is the variability,” Dr. Mojumder noted. “Why do some people get a severe form of illness? Why others do not? Why do some people have a long road to recovery, whereas others are pretty asymptomatic?”

They both urge people to follow the COVID-19 safety precautions to stop the spread and prevent people from ending up in the hospital because they do not know how individuals will react.

“My biggest frustration with COVID-19 is the lack of seriousness that the disease is given in some areas and by some people in our community,” Dr. Lahren expressed. "Maybe they haven’t been touched by it yet or they don’t realize how serious it is. I would say the most difficult thing is watching patients die alone or die without their families. They’re never alone, there’s always a nurse or myself or one of my partners there, but we’re not their family and their families can’t be in with them frequently so patients are having to die with a loved one on an iPad or an iPhone and that would be the hardest thing.”

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