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

COVID AND CLOTTING: A BRIEF LOOK

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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

Read Blog
Simple Habits to Avoid High Cholesterol

Simple Habits to Avoid High Cholesterol

High cholesterol is one of the leading causes of heart disease and stroke worldwide. In India, rising cholesterol levels are becoming more common due to sedentary lifestyles, unhealthy food habits, and stress. But the good news is—you can prevent high cholesterol naturally with a few simple habits.

In this blog, we’ll explore easy, everyday steps you can take to keep your cholesterol levels in check and protect your heart.

 

What Is Cholesterol?

Cholesterol is a fatty substance found in your blood. While your body needs some cholesterol to build cells and hormones, too much of the wrong type—called LDL (low-density lipoprotein)—can be harmful. It can build up in your arteries and increase your risk of heart disease and stroke.

There’s also HDL (high-density lipoprotein), which is the “good” cholesterol that helps remove LDL from your body.

 

Why High Cholesterol Is Dangerous

  • Clogs arteries and restricts blood flow
     

  • Increases risk of heart attacks and strokes
     

  • Can lead to high blood pressure
     

  • May affect kidney and liver function
     

The scariest part? High cholesterol usually has no symptoms. That’s why it’s called a silent killer and must be managed before problems begin.

 

7 Simple Habits to Avoid High Cholesterol

 

1. Eat Fiber-Rich Foods Daily

Soluble fiber binds with cholesterol in the gut and removes it from your body.

Best foods for fiber:

  • Oats and barley
     

  • Apples, pears, and oranges
     

  • Beans and lentils
     

  • Flaxseeds and chia seeds
     

Tip: Start your morning with a bowl of oatmeal and add a fruit—it’s a heart-healthy breakfast!

 

2. Stay Active Every Day

Physical activity boosts HDL (good cholesterol) and burns fat that raises LDL.

What to do:

  • Walk briskly for 30 minutes a day
     

  • Try yoga, cycling, or dancing
     

  • Use stairs instead of the lift
     

  • Take short walks after meals
     

Even small movements throughout the day matter.

 

3. Cut Down on Saturated & Trans Fats

These fats raise your LDL cholesterol quickly.

Avoid:

  • Fried food, chips, and baked snacks
     

  • Ghee-heavy sweets
     

  • Processed foods with “hydrogenated oils”
     

Choose instead:

  • Olive oil or mustard oil
     

  • Grilled or baked foods
     

  • Fresh fruits and nuts as snacks
     

 

4. Manage Your Stress

Stress affects your hormones and may raise your cholesterol over time.

Try this:

  • Practice deep breathing or meditation
     

  • Do relaxing hobbies like reading or gardening
     

  • Take tech breaks and sleep 7–8 hours daily
     

  • Talk to someone if you’re feeling overwhelmed
     

A calm mind supports a healthy heart.

 

5. Stay Hydrated and Cut Sugary Drinks

Water helps regulate body functions and weight, which both impact cholesterol.

Do this:

  • Drink 8–10 glasses of water daily
     

  • Avoid soft drinks and energy drinks
     

  • Switch to herbal teas or infused water
     

Too much sugar can raise triglyceride levels, a type of fat in your blood.

 

6. Quit Smoking and Limit Alcohol

Smoking lowers good cholesterol and damages arteries. Alcohol, in excess, can also spike cholesterol and blood pressure.

Tip:
Even reducing smoking or drinking frequency helps your heart function better.

 

7. Get Regular Cholesterol Tests

Don’t wait for symptoms. Get your lipid profile checked every year, especially if you have:

  • A family history of heart disease
     

  • Diabetes or high blood pressure
     

  • Obesity or unhealthy lifestyle habits
     

Suggested Test:
Lipid Profile Test by Thyrocare via SecondMedic.com – includes LDL, HDL, total cholesterol, and triglycerides with home sample collection.

 

Normal Cholesterol Levels:

Type

Ideal Range

Total Cholesterol

Below 200 mg/dL

LDL (Bad)

Below 100 mg/dL

HDL (Good)

Above 40 mg/dL (men), 50 mg/dL (women)

Triglycerides

Below 150 mg/dL

 

Tips to Book a Test via SecondMedic:

  1. Visit www.secondmedic.com
     

  2. Search for Lipid Profile Test – Thyrocare
     

  3. Select home collection
     

  4. Fast for 9–12 hours before the test
     

  5. Get results in 24–48 hours
     

 

Bonus Tips

  • Replace white rice with brown rice or millets
     

  • Choose low-fat milk and curd
     

  • Snack on almonds or walnuts
     

  • Cook at home more often than eating out
     

  • Maintain a healthy weight
     

 

Conclusion

You don’t need fancy diets or harsh treatments to manage cholesterol. Just a few simple daily habits can make a big difference in protecting your heart.

By eating better, moving more, managing stress, and staying hydrated, you can keep your cholesterol in check without medication in many cases.

Make your heart health a priority starting today!

Start following these simple habits to avoid high cholesterol and keep your heart happy for years to come.

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