Something I've been suggesting for months, but I'm specifically going to ask for heparin.
I'm going to be asking for heparin as a blood thinner because of this:
Common FDA-approved drug may effectively neutralize virus that causes COVID-19
But your doctor needs to resolve this conundrum:
Preemptive Blood Thinners Tied to More Deaths in Hospitalized COVID-19 Patients
But Hypoxemia suggests something different. The transit of the bubbles suggested vasodilation of the lung capillaries, Poor said. That could mean that blood may be flowing too fast through those capillaries to absorb enough oxygen.
COVID Hypoxemia: Finally, an Explanation
The latest here:
Blood Thinners Again Linked to COVID-19 Survival in Hospital
— This time with better methodology
Anticoagulation for patients hospitalized with COVID-19 was associated with lower risk of death or intubation in an observational study from New York City's pandemic peak.
In-hospital mortality risk was a relative 50% lower with standard prophylactic dosing and 47% lower with higher therapeutic-level dosing after adjustment for other factors, both statistically significant when compared with COVID-19 patients in Mount Sinai hospitals not given an anticoagulant (mortality rates of 21.6%, 28.6%, and 25.6%, respectively).
Intubation was less likely for anticoagulant-treated COVID-19 patients as well (adjusted HR 0.69 with prophylactic dosing, 95% CI 0.51-0.94, and aHR 0.72 with therapeutic dosing, 95% CI 0.58-0.89), reported Anuradha Lala, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in the Journal of the American College of Cardiology.
Major bleeding events adjudicated by clinician chart review turned up a "low" rate of 1.7% (33 of 1,959) on prophylactic anticoagulation and 3% (27 of 900) on therapeutic anticoagulation compared with 1.9% (29 of 1,530) on no anticoagulant during hospitalization.
"The study has severe limitations due to its retrospective nature," cautioned Stephan Moll, MD, of the University of North Carolina at Chapel Hill Hemophilia and Thrombosis Center.
"However, NIH prospective studies on inpatient and outpatient [prophylaxis] comparing different anticoagulation management strategies are planned and hopefully starting soon so that we can get beyond all these retrospective studies and data of the last few months, which all have ascertainment bias," he told MedPage Today.
Lala's group had previously reported on their experience with anticoagulation among 2,773 patients treated early in the pandemic, finding an in-hospital survival advantage with therapeutic-dose anticoagulation among mechanically ventilated patients and with longer duration anticoagulation.
A subsequent study had suggested elevated mortality risk with preemptive therapeutic-dose anticoagulation in COVID-19 patients.
The new data included 4,389 adults with laboratory-confirmed SARS-CoV-2 infection admitted from March 1 to April 30, 2020, at the five New York City hospitals in the Mount Sinai system.
The researchers conservatively classified anyone treated for less than 48 hours with an anticoagulant as fitting the control group, unless the drug was stopped due to major bleeding. Patients discharged within 24 hours, as well as those treated with both therapeutic and prophylactic regimens, were excluded.
The study also evaluated the first 26 autopsies on COVID-19 patients in the health system, which turned up thromboembolism in 11 (42%), while it had been suspected pre-mortem in only one. "Our findings are in line with what other studies have shown," Lala said. "We're seeing more clots than we would have ever suspected previously."
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