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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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Digital Pharmacy Platforms India: How SecondMedic Is Transforming Medicine Access Through Technology

India’s healthcare system is rapidly digitizing, and one of the most impactful innovations is the rise of digital pharmacy platforms. These platforms make it easier for people to order medicines online, manage prescriptions, and access healthcare services without visiting a physical store.

As chronic diseases, online consultations, and digital health records become more common, digital pharmacy solutions are now a vital part of India's healthcare infrastructure. SecondMedic plays a key role in this evolution by providing secure, fast, and integrated digital pharmacy services.

What Are Digital Pharmacy Platforms?

Digital pharmacy platforms are online systems that allow users to:

Order prescription medicines
Upload or sync digital prescriptions
Schedule refills
Purchase OTC products
Track orders
Access pharmacist support

Instead of visiting a traditional pharmacy, users can manage medication needs from anywhere in India.

Why Digital Pharmacies Matter in India

India sees high demand for medicines due to:

Rising chronic diseases
Aging population
Urban mobility challenges
Increasing telemedicine adoption
Growing digital health awareness

Digital pharmacies bridge the gap between medical consultation and medication access.

Key Benefits of Digital Pharmacy Platforms

1. Convenience and Accessibility

Patients can order medicines anytime, especially helpful for elderly individuals or those living in remote areas.

2. Time and Cost Savings

Digital ordering eliminates long queues, multiple store visits, and pricing uncertainties.

3. Verified, Authentic Medicines

Reputed platforms ensure drugs come from licensed pharmacies with full batch traceability.

4. E-Prescription Integration

Digital prescriptions reduce manual errors and support seamless ordering.

5. Chronic Disease Medication Management

Automated refill reminders and scheduled deliveries help maintain treatment consistency.

6. Privacy and Discretion

Useful for sensitive medication categories where users may prefer confidential ordering.

The Growing Digital Pharmacy Market in India

According to Statista 2025:

The Indian e-pharmacy market is expected to reach USD 10 billion by 2027.
Nearly 35 percent of urban households now use digital pharmacy services.
Chronic disease patients are the largest user segment.

Government initiatives like ABDM also promote secure and standardized digital prescriptions.

SecondMedic’s Digital Pharmacy Ecosystem

SecondMedic integrates pharmacy services seamlessly within its broader digital health platform.

1. Online Medicine Ordering

Users can order medicines directly through the SecondMedic app or website.

2. E-Prescription Sync

Prescriptions from SecondMedic doctors sync automatically, reducing errors and delays.

3. Verified Inventory

All medicines are sourced from certified pharmacies with temperature-controlled storage and valid expiry cycles.

4. Chronic Care Refill System

For diabetes, hypertension, thyroid disorders, and cardiac conditions, patients can schedule monthly refills.

5. Real-Time Tracking

Users get live updates on order status, dispatch, and delivery.

6. Secure Payment Gateway

Digital payments are supported through encrypted channels, ensuring safety and transparency.

7. Integration with Medical Consultations

After virtual consultations, prescribed medicines can be ordered instantly on the same platform.

How Digital Pharmacy Platforms Support Telemedicine

Telemedicine has become a cornerstone of modern healthcare. Digital pharmacies complement this by:

Enabling immediate access to prescribed medicines
Ensuring continuity of care
Reducing patient dependency on physical pharmacies
Streamlining doctor-to-pharmacy communication

Together, they create an efficient, patient-centered care loop.

Challenges in India’s Pharmacy System and How Digital Platforms Solve Them

1. Fragmented Pharmaceutical Distribution

Digital systems bring transparency and accountability.

2. Prescription Mismanagement

E-prescriptions minimize errors and duplication.

3. Limited Accessibility in Rural Areas

Digital ordering delivers medicines directly to underserved regions.

4. Inconsistent Medicine Availability

Real-time inventory ensures availability and alternatives.

5. Lack of Patient Awareness

Digital platforms offer information on dosage, interactions, and side effects.

Regulatory Framework for Digital Pharmacies in India

To ensure safety and compliance, digital pharmacies follow:

Drugs and Cosmetics Act (1940)
Pharmacy Practice Regulations
ABDM standards for digital prescriptions
DPDP Act for data security
CDSCO guidelines for online pharmacies

SecondMedic maintains full compliance with regulatory requirements.

Future of Digital Pharmacy in India

The sector is expected to grow due to:

AI-based medicine recommendations
Smart refill systems
Blockchain for supply chain verification
Automated pharmacy logistics
Drone-based delivery pilots in some states

SecondMedic is actively building tools to support next-generation pharmacy automation and integrated digital care.

Why Patients Trust SecondMedic’s Pharmacy System

Authentic and verified medicines
Transparent pricing and secure payments
Direct connection with healthcare consultations
Support for chronic care medication
Nationwide delivery capability
User-friendly ordering process
Compliance with all digital health safety standards

SecondMedic brings reliability, convenience, and safety under one unified digital healthcare platform.

Conclusion

Digital pharmacy platforms are redefining how India accesses medicines. They improve convenience, enhance safety, support telemedicine, and empower patients to manage chronic conditions more effectively. SecondMedic’s digital pharmacy provides an integrated solution that combines e-prescriptions, secure ordering, and nationwide delivery to simplify healthcare access.

To order medicines or explore digital pharmacy services, visit www.secondmedic.com

References

Statista – India E-Pharmacy Market Outlook 2025
IMARC Group – Digital Healthcare Market India 2025
NITI Aayog – Digital Health Tech Landscape 2024
ABDM – Digital Prescription Guidelines
FICCI – Healthcare Innovation Report 2024

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