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Published on: Apr 30, 2020
3 minute read
By: Dr Rajan Choudhary

COVID AND CLOTTING: A BRIEF LOOK

At the Mount Sinai hospital, a case series of five patients have been put together, ready to be published in the New England Journal of Medicine. It details patients aged 33, 37, 39, 44, and 49 who all began to experience a sudden onset of symptoms including slurred speech, confusion, drooping on one side of the face, and feeling dead in one arm. At the time of writing one has sadly died, two remain hospitalized and one is in rehab. Only the youngest is able to speak. All of them were found to be COVID positive.

This drastic case series highlights a growing problem of strokes and clotting disorders in COVID patients, one noted by medics across the world. This blog looks at whether this is a common occurrence and what may be causing it.

Before reading this blog it will be helpful to read our previous blog on why and how blood clots.

THE START

In mid-February Tang et al published a paper noting that patients with abnormal clotting parameters were associated with a poorer prognosis. In their study, 11% of their patients died, but out of these patients, 71% had these abnormal parameters, compared to just 0.6% of survivors. The patients who died also demonstrated DIC (disseminated intravascular coagulation), a condition in which clotting is triggered in the patients' blood across the body, not just at the site of injury.

There is one major issue with this study. In most European hospitals patients receive anticoagulant medications on a daily basis. This is because lying in a hospital bed when ill can promote the formation of clots in your legs. Most hospitals in China do not provide this anticoagulation, but even then the incidence of clotting is remarkably high.

After this, the evidence begins piling up. 9th April, Cui et al found 25% of patients with severe COVID had clots in their legs, of which just under half died. Looking at a specific clotting parameter (D-DIMER) was remarkably accurate at predicting high-risk patients.

Italian doctors found in 16 patients in critical care with severe Acute Respiratory Distress Syndrome (a severe inflammatory condition caused by COVID) also had deranged clotting parameters.

French studies had found these sickest patients often had large clots in their lungs, blocking blood flow in the lung and causing severe issues in keeping the patient's blood well oxygenated.

Some studies showed even patients hooked up to artificial lungs (known as ECMO) were not safe from the problems caused by excessive clotting.

WHY?

So why is this occurring? As with everything in medicine, the answer is complicated and usually multifactorial. So we will simplify it.

We must look at the platelets in our blood. These fragmented cells have an important role in triggering the clotting cascade and creating a clot. During an infection white blood cells (important immune cells responsible for finding and destroying invading organisms) release many chemical signals around an infection site. This triggers platelets, the formation of small protein meshes that can literally net the viral particles in the blood.

But it looks like they have an anti-viral role as well. Researchers have found specialist receptors on platelets that recognize viruses in the blood, leading to the release of specialist anti-viral molecules that target and destroy the viruses. This is an interesting finding because it is white blood cells that are known to destroy invading organisms.

So how does it go wrong? In severe infections, there is a very large viral load, and this can cause an excessive response. Too many white blood cells release too many chemical signals, causing too many platelets to activate. The same thing can occur with the virus directly activating too many platelets at once. This results in clots forming in the blood throughout the body, including the lung and the brain. It is another instance of the body falling victim to its own protective mechanism.

A second problem is that as these platelets are activated, they and the clotting proteins in the patient’s blood are “used up”. This is dangerous, because without these platelets and clotting proteins the body is unable to stop any bleeding sites. Profuse bleeding can occur from small injuries, further complicating the treatment of the patient.

So what can be done?

Hospitals have already started looking at giving patients with severe COVID anticoagulation therapy. And it seems in patients with deranged clotting, giving anticoagulation therapy can lower mortality. The International Society on Thrombosis and Haemostasis (Clotting) has recommended that patients with severe COVID receive high dose anticoagulation medication to thin their blood, because these patients are at such high risk of clots. This regime will be used for hospital patients and those in critical care.

And what about for the everyday public? Should we be worried? So far the data suggests this is only happening in people suffering from severe symptoms of COVID. But the incident in New York certainly raises some questions, and it will be interesting to read their report in NEMJ. Should you panic and start taking anti-coagulant medication at home? Definitely not. But what you should do is be educated in the symptoms of common diseases caused by clots. Diseases such as strokes and DVTs.

STROKE

Remember, act F.A.S.T

Facial Droop on one side
Arm or hand on one side feels numb or weak with reduced power (same in one leg)
Slurred speech making it difficult to understand
Time to phone an ambulance

Other symptoms can include sudden loss in balance, sudden loss in vision in one eye, problems swallowing, and more.

DVT

Look out for a swollen, painful calf on one side that is hot to touch.

PULMONARY EMBOLISM

If you have a swollen, painful calf and are also having trouble breathing, with some sharp stabbing pain in your chest, contact the emergency services as soon as possible.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Digestive System Disorders: Common Causes, Symptoms, and Prevention Tips

The digestive system plays a vital role in overall health by breaking down food, absorbing nutrients and eliminating waste. When this system does not function properly, it can lead to discomfort, poor nutrition and chronic illness. Digestive system disorders are increasingly common due to modern lifestyles, dietary habits and stress. Understanding their causes, symptoms and prevention strategies is essential for maintaining long-term gut health.

Public health research shows that a large proportion of adults experience digestive symptoms at some point in their lives, yet many delay seeking care until problems become severe.

What Are Digestive System Disorders?

Digestive system disorders are conditions that affect:

the oesophagus
stomach
intestines
liver
pancreas
gallbladder

They may be temporary or chronic and range from mild functional issues to serious inflammatory or structural diseases.

Common Digestive System Disorders

Acid Reflux and GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into the oesophagus.

Symptoms include:

heartburn
chest discomfort
sour taste in mouth
difficulty swallowing

Long-term reflux can damage the oesophagus if untreated.

Irritable Bowel Syndrome (IBS)

IBS is a functional bowel disorder.

Symptoms include:

abdominal pain
bloating
diarrhoea or constipation
alternating bowel habits

Stress and diet often trigger symptoms.

Constipation

Constipation involves infrequent or difficult bowel movements.

Causes include:

low fibre intake
dehydration
sedentary lifestyle

Chronic constipation affects comfort and gut function.

Diarrhoea

Diarrhoea results from rapid bowel movements.

Common causes include:

infections
food intolerance
medication side effects

Persistent diarrhoea may lead to dehydration and nutrient loss.

Peptic Ulcer Disease

Ulcers are sores in the stomach or intestinal lining.

Symptoms include:

burning stomach pain
nausea
bloating

They are often linked to infections or long-term medication use.

Inflammatory Bowel Disease (IBD)

IBD includes conditions like Crohn’s disease and ulcerative colitis.

Symptoms include:

chronic diarrhoea
abdominal pain
weight loss
fatigue

IBD requires long-term medical management.

Common Symptoms of Digestive Disorders

Digestive system disorders often present with:

abdominal pain or cramps
bloating and gas
nausea or vomiting
constipation or diarrhoea
heartburn
unexplained weight changes

Symptoms may fluctuate and worsen with stress or poor diet.

Causes of Digestive System Disorders

Poor Dietary Habits

Diets high in:

processed foods
refined sugars
unhealthy fats

strain the digestive system and alter gut microbiota.

Stress and Mental Health

Chronic stress affects gut-brain communication, worsening digestive symptoms.

Infections

Bacterial, viral or parasitic infections disrupt gut function.

Food Intolerances

Lactose, gluten or other intolerances cause digestive distress.

Sedentary Lifestyle

Lack of physical activity slows digestion and bowel movement.

Medication Use

Certain medications irritate the stomach lining or alter gut flora.

Who Is at Higher Risk?

People at increased risk include:

individuals with poor diet
those under chronic stress
older adults
people with family history of gut disease
individuals with sedentary lifestyles

Early lifestyle correction reduces risk significantly.

Diagnosis of Digestive Disorders

Evaluation may include:

medical history
physical examination
blood tests
stool tests
imaging or endoscopy

Diagnosis depends on symptom severity and duration.

Treatment Approaches

Medical Management

Treatment varies by condition and may include:

acid suppressants
anti-inflammatory medications
probiotics
antibiotics when needed

Dietary Modifications

increase fibre intake
limit trigger foods
eat regular meals
avoid excessive alcohol

Diet plays a central role in gut health.

Lifestyle Changes

manage stress
exercise regularly
stay hydrated
maintain sleep routine

Healthy habits support digestive function.

Prevention Tips for Digestive Health

Eat a Balanced Diet

Include fruits, vegetables, whole grains and lean proteins.

Stay Hydrated

Water supports digestion and prevents constipation.

Manage Stress

Mindfulness and relaxation techniques improve gut-brain balance.

Be Physically Active

Movement stimulates bowel activity and gut motility.

Avoid Smoking and Excess Alcohol

These irritate the digestive tract and worsen symptoms.

Seek Early Medical Advice

Early care prevents complications and chronic disease.

Long-Term Impact of Ignoring Digestive Problems

Untreated digestive disorders may lead to:

nutrient deficiencies
chronic inflammation
poor quality of life
increased disease complications

Early intervention is more effective and less invasive.

When to Consult a Doctor

Medical advice is recommended if:

symptoms persist beyond weeks
pain is severe
blood appears in stool
unexplained weight loss occurs

Prompt evaluation ensures safe management.

Conclusion

Digestive system disorders are common but often underestimated health issues. Symptoms such as bloating, pain, constipation and heartburn may seem minor initially but can signal deeper problems if ignored. Understanding causes, recognising early symptoms and adopting preventive habits help protect digestive health. With timely care, balanced nutrition and healthy lifestyle choices, most digestive disorders can be effectively managed, allowing the digestive system to function smoothly and support overall wellbeing.

References

Indian Council of Medical Research (ICMR) – Digestive Health and Nutrition Reports
World Health Organization (WHO) – Digestive Disorders and Gut Health Guideline
National Institute of Nutrition (NIN) – Dietary Fibre and Gut Health Researc
Lancet – Gastrointestinal Disease and Prevention Studies
Indian Journal of Gastroenterology – Digestive Disorder Research
Statista – Digestive Health Trends and Lifestyle Factors

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