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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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How Remote Patient Monitoring is Enhancing Chronic Disease Management

Managing chronic diseases like diabetes, hypertension, heart conditions, and asthma is a daily challenge for millions of people worldwide. These conditions require continuous care, regular monitoring, and timely medical interventions. In recent years, one innovation has been transforming this space dramatically — Remote Patient Monitoring (RPM).

This modern healthcare solution is reshaping how patients and doctors manage long-term health issues, offering more convenience, better health outcomes, and cost-effective care. In this blog, we will explore how remote patient monitoring is enhancing chronic disease management, and why it’s becoming essential for modern healthcare.

What is Remote Patient Monitoring (RPM)?

Remote Patient Monitoring is a system where patients use digital technologies to collect their health data and send it to healthcare providers in real-time or at scheduled intervals. This can include data like:

Blood pressure
Blood sugar levels
Oxygen saturation
Heart rate
Weight
Medication usage
Physical activity levels

These devices may be as simple as a smartwatch or a connected glucose monitor. Healthcare professionals review this data remotely and take necessary action if any red flags appear.

The Growing Need for RPM in Chronic Disease Care

Chronic diseases are not just long-term; they are often unpredictable and require personalized care. Traditional healthcare models — where patients visit the doctor every few months — don’t always provide timely insights.

RPM fills this gap by:

Offering real-time monitoring
Reducing the need for frequent in-person visits
Helping doctors intervene before conditions worsen

In essence, it brings the doctor’s care to the patient’s home.

Benefits of RPM in Managing Chronic Diseases

Let’s look at the many ways RPM is helping both patients and healthcare providers manage chronic conditions more effectively.

1. Early Detection of Complications

RPM allows for continuous health monitoring, which makes it easier to spot issues early. For instance, if a patient's blood pressure readings are consistently high, a doctor can be alerted immediately and adjust medication or recommend lifestyle changes.

2. Better Patient Engagement

Patients become more aware and involved in their own care when they can track their health data daily. This awareness often leads to better compliance with medication, diet, and exercise.

3. Reduced Hospital Visits and Readmissions

With RPM, many flare-ups or emergencies can be avoided. This reduces the number of emergency room visits and prevents unnecessary hospital readmissions, which also saves healthcare costs.

4. Personalized and Data-Driven Care

Doctors get detailed and continuous insights into each patient’s health trends. This helps them tailor treatment plans based on real-time data, not just occasional checkups.

5. Improved Access to Care

RPM is a game-changer for people living in rural or underserved areas where regular visits to specialists are not possible. It ensures they receive the same level of care without having to travel.

RPM in Action: Real-Life Applications

Remote Patient Monitoring is already being used effectively in many chronic diseases:

Diabetes Management: Smart glucose monitors send daily sugar readings to doctors who can adjust insulin doses as needed.
Heart Disease: Patients use connected ECG devices or wearable heart monitors. Any irregular heart rhythm alerts the doctor in real-time.
COPD and Asthma: Oxygen levels and respiratory rates are tracked remotely. Doctors can act before a patient suffers a severe attack.
Hypertension: Blood pressure monitors transmit data daily, making it easier to control and manage high BP without delay.

Technology Behind RPM

Modern RPM systems rely on:

Wearable Devices: Smartwatches, fitness trackers, glucose monitors, etc.
Mobile Health Apps: These apps collect and transmit data securely to doctors.
Cloud-Based Platforms: All patient data is stored and analyzed in the cloud, which doctors can access instantly.
AI and Predictive Analytics: Advanced systems use AI to detect patterns and even predict potential health risks before they happen.

The combination of these technologies creates a smooth, integrated care experience for the patient and a more effective way for healthcare providers to manage diseases.

Challenges in RPM — And How They’re Being Solved

Like any innovation, RPM has some challenges:

Data Privacy: Patients worry about how their health data is handled. The solution? Encrypted data storage and strict compliance with privacy laws like HIPAA.
Technology Access: Not everyone has access to smart devices or reliable internet. Governments and private companies are working to improve access in rural and low-income areas.
Digital Literacy: Elderly or less tech-savvy patients may find RPM devices hard to use. To solve this, devices are being made simpler, and training programs are often offered.

The Future of Chronic Disease Management with RPM

The future looks promising. With the rise of 5G, AI, and Internet of Things (IoT), RPM is becoming more efficient and accessible. Hospitals and clinics are now integrating RPM into their primary care models, insurance companies are beginning to cover it, and patients are demanding more home-based care options.

As this technology continues to evolve, we can expect:

Faster interventions
Better long-term health outcomes
Lower healthcare costs
More empowered patients

Conclusion: Transforming Care, One Device at a Time

Remote Patient Monitoring is not just a trend — it’s a vital solution to one of healthcare’s biggest challenges: managing chronic diseases. It empowers patients, supports doctors, and makes continuous, personalized care possible without needing to be physically present at a hospital or clinic.

If you're living with a chronic condition or caring for someone who is, consider asking your doctor about RPM options. It's an investment in better health, peace of mind, and independence.

Ready to experience better chronic care? Learn more about how remote patient monitoring is enhancing chronic disease management and take a step toward healthier living today