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Warfarin advantage

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Protimenow

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This is interesting, but, in the study, heparin was used as the anticoagulant. Still, I suspect that people using warfarin (and possibly Eliquis and the other anticoagulants) may also get benefits. One somewhat troubling thing is that, for some, those on heparin still died, but it took a week longer.
 

Thomas

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While there were deaths (not a silver bullet), buying time for a possible turnaround is a good thing.

I'd be very interested in knowing the dosage that were administered and what the target INR ranges we're.

Don't let Trump know about this. He'll be doing the "what could go wrong" speech again.
 

Protimenow

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He'll buy stock in the companies that make Eliquis and Pradaxa, and promote those - there's no money to be made in warfarin.

The study used Heparin, not warfarin, as an anticoagulant. I'm not sure about whether or not Heparin affects INR and can be measured by labs or meters.

I'm not aware of any studies relating anticoagulation from warfarin with outcomes.
 

Paleowoman

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Article in the Telegraph this evening: Blood-thinning drugs can help save Covid-19 patients' lives

"The NHS is set to issue hospitals with fresh guidance on blood thinning, which is likely to eventually lead to carefully administered higher doses for the critically ill."

"Specialists at Royal Brompton Hospital’s severe respiratory failure service established the clearest link yet between Covid-19 and clotting by using hi-tech dual energy CT scans to take images of lung function in their most serious patients."
 

pellicle

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I had assumed that the patients with hyper-coagulation would be presenting lower PT / INR readings. Not so:
"Error - Cookies Turned Off"
Non-survivors have higher PT time than survivors!
however the elevated D-dimer and the pre-triggered thromboplastin may have not occured had they been on on AC

Something thats important to remember is that the INR= 1 is an average, not a normal
 

leadville

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so i understand this correctly , the group that had the poorest outcome had higher PT time.
& also had the higher D dimmer level which is an indication of clots ?

If they had clots then the bodies response is to try to break down the clots ( ergo higher PT ) ?

So the potential warfarin benefit is that it will prevent the clot beforehand ?
 

Protimenow

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So - here's a bizarre thought:

If a low INR reduces the risk of clotting if a person gets COVID-19, wouldn't a low dose of warfarin (1 mg, 2 mg) be effective at slightly reducing the risk of clots in everyone who doesn't test positive for 19? Would it be more beneficial in people who DO test positive, but haven't yet experienced symptoms?

Once the pandemic is over - or a person's antibody test shows that they've already have it, the warfarin can be eliminated.

This sounds very extreme - and few people would want to take 'rat poison' unless they've got a damned good reason (aside from the possibility that they'll form clots if they get a bad case of the virus), and the benefits can't be proven (without finding people who are taking warfarin have better outcomes that can be attributed to the higher INR). This may warrant four or five years of research to test the validity of this assumption (and, it's hoped, research will wrap up long after an effective vacine is found and distributed globally).
 

pellicle

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So the potential warfarin benefit is that it will prevent the clot beforehand ?
that's my conjecture, given that d-dimer tests indicate the presence of thrombosis and warfarin reduces that, so being on warfarin >beforehand< may confer a greater survival


If they had clots then the bodies response is to try to break down the clots ( ergo higher PT ) ?
I'm not sure of that relationship, I've never read anything to make me think that.
 

Protimenow

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I think it'll probably take more than warfarin to break down clots that have already developed. Warfarin slows down clotting and can prevent clots from forming, but once formed, I doubt that warfarin has much (or any) effect.

It's kind of like using an oil additive that prevents sludge from forming in the engine -- it takes something else (perhaps an engine rebuild or a really good filter) to take care of the sludge -- the additive is a good preventive, but it isn't a cure.
 

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