• 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

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National Dentist Day 2025

National Dentist Day: Best Oral Hygiene Tips Shared by Experts

Every year, on March 6th, National Dentist Day is celebrated to recognize the invaluable contributions of dentists in maintaining our oral health. This special day also serves as a reminder of the importance of good oral hygiene habits. Whether you're looking to improve your daily dental routine or seeking expert advice, we’ve compiled the best oral hygiene tips shared by dentists to help you achieve a healthy and confident smile.

1. Brush Properly, Not Just Regularly

Brushing twice a day is essential, but how you brush matters just as much as how often. Experts recommend using a soft-bristled toothbrush and fluoride toothpaste. Follow these steps for effective brushing:

  • Use a gentle, circular motion rather than scrubbing.

  • Brush for at least two minutes twice a day.

  • Ensure you clean all tooth surfaces, including the back molars and gum line.

2. Flossing is Non-Negotiable

Flossing removes food particles and plaque from between your teeth where your toothbrush can’t reach. Dentists suggest flossing at least once a day to prevent cavities and gum disease. If traditional flossing is difficult, consider using:

  • Water flossers

  • Interdental brushes

  • Floss picks

3. Rinse with Mouthwash for Extra Protection

Using an antibacterial mouthwash helps reduce plaque, prevents bad breath, and protects against gum disease. Look for a fluoride-based or alcohol-free mouthwash, especially if you have sensitive gums.

Tip: Rinse for 30 seconds after brushing and flossing for best results.

4. Eat a Tooth-Friendly Diet

What you eat significantly impacts your oral health. Dentists recommend incorporating the following foods into your diet:

  • Dairy products (milk, cheese, yogurt) to strengthen enamel.

  • Crunchy fruits and vegetables (apples, carrots) to naturally clean teeth.

  • Nuts and seeds for essential minerals like calcium and phosphorus.

  • Green tea for its antibacterial properties.

Avoid excessive consumption of sugary snacks, acidic beverages, and sticky candies, which can erode enamel and lead to cavities.

5. Stay Hydrated and Limit Sugary Drinks

Drinking plenty of water helps wash away food particles and bacteria, keeping your mouth fresh and clean. Limit soda, sports drinks, and coffee, as they can stain teeth and contribute to decay.

Pro Tip: If you drink sugary or acidic beverages, use a straw to minimize direct contact with your teeth.

6. Replace Your Toothbrush Regularly

A worn-out toothbrush is ineffective at cleaning your teeth. Dentists recommend replacing your toothbrush every 3-4 months or sooner if the bristles are frayed. Using an electric toothbrush can also improve plaque removal.

7. Schedule Regular Dental Checkups

No matter how diligent your oral hygiene routine is, visiting your dentist every six months is crucial for professional cleanings and early detection of dental issues. Regular checkups can help prevent cavities, gum disease, and even serious health conditions linked to poor oral health.

8. Protect Your Teeth While Playing Sports

If you engage in contact sports, wearing a custom-fitted mouthguard can protect your teeth from injuries and fractures. This simple preventive measure can save you from costly dental treatments.

9. Avoid Smoking and Tobacco Products

Smoking and tobacco use are major contributors to gum disease, tooth loss, and oral cancer. If you’re looking for another reason to quit, your oral health is a great motivation. Talk to your dentist about resources to help you quit.

10. Teach Kids Good Oral Hygiene Habits Early

Children should learn proper oral hygiene habits from a young age. Encourage them to:

  • Brush their teeth with fluoride toothpaste.

  • Floss regularly.

  • Visit the dentist every six months.

  • Avoid excessive sweets and sugary drinks.

Setting a strong foundation for oral health can prevent future dental issues and ensure a lifetime of healthy smiles.

Conclusion

This National Dentist Day, take the opportunity to improve your oral care routine by following these expert tips. Good oral hygiene isn’t just about having a bright smile—it’s also essential for overall health and well-being. Show appreciation for your dentist by prioritizing your dental health and scheduling your next checkup.

For personalized dental care advice, consult a professional at SecondMedic, where expert guidance helps you maintain optimal oral health.

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