A study (paywalled) published Wednesday in the Journal of the American College of Cardiology (summary news story from J ACC, not paywalled) reports the results of a retrospective review from the Mount Sinai hospital system in New York. A retrospective review of 4,389 COVID cases found approximately 50% lower mortality among those patients in anti-coagulant (AC) therapy.
Importantly there was no significant difference between patients who were previously on blood thinners and those in who AC therapy was begun within 48 hours of admission to the hospital. Patients on AC therapy had reduced need to be intubated as well.
Study conclusions:
Conclusions AC was associated with lower mortality and intubation among hospitalized COVID-19 patients. Compared to prophylactic AC, therapeutic AC was associated with lower mortality, though not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may inform trials to determine optimal AC regimens.
Serious bleeding events (defined as needed 2 or more units of red blood cells in a 48 hour period) occurred in less than 3% of patients on AC therapy.
Clotting events have been shown to be a significant mortality factor in COVID. This review of patient histories shows that common anti-coagulants like warfarin may provide significant survival benefits.
As this was a retrospective study the authors recommend a prospective study to verify results.
It’s interesting. But raises questions on who (and why) folks were started on anticoagulation, whether due to cornorbiditues, Covid severity, previous use or clots, anticipated immobilization, stroke risk, atrial fibrillation, etc. It also raises the question on whether aspirin or similar platelet inhibitors have some benefit, possibly at lower risk or due to anti-inflammatory effects.
My understanding, and certainly my own personal experience, is that platelet inhibitors are routinely used in conjunction with low-dose coated aspirin. In my case it was the platelet inhibitor Brilinta along with daily doses of aspirin and other stuff following stent implants. After a couple of years, I was switched to Plavix (plus aspirin) over concerns about the long-term use of Brilinta, although it had no immediately apparent side effects.
I sure hope that this doesn’t cause some sort of run on platelet inhibitors the same way hoarders cleaned out a lot of other essentials. For some of us, platelet inhibitors are life-sustaining necessities.
There have been reports for months of covid patients having weird and dangerous clots. I read one article about a surgeon who was manually removing a blood clot from the brain of a patient and under the scanner, he WATCHED A NEW CLOT FORM. He described it as horrifying.
I wouldn’t be surprised if a lot of covid patients are given anticoagulants because one of their doctors had read reports like the ones I have read, and sees some potential sign of clotting, and decided to give it a try.
Anyway, this is a welcome preliminary finding and I hope there are good follow-ups and prospective studies soon.
Whether aspirin is used with anticoagulants depends on the indication. It is still a matter of occasional debate. By itself, aspirin is less effective than anticoagulants for some conditions. But it is also cheaper, has some other benefits in certain populations and some people cannot take anticoagulants. For Covid, I doubt the issue has been definitively settled because risks can multiply when on both.
So as someone on a statin I am aware that one of the ways that statins reduce risks of cardiovascular morbidity and mortality (along with lowering cholesterol and anti inflammatory properties, is by decreasing platelet function. So I just searched for articles about statins and Covid and dayum.
This is an article about how covid may kill through a “Bradykinin storm”, rather than a cytokine storm:
The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of Covid-19’s deadly effects. Jacobson’s team says in their paper that “the pathology of Covid-19 is likely the result of Bradykinin Storms rather than cytokine storms,” which had been previously identified in Covid-19 patients, but that “the two may be intricately linked.” Other papers had previously identified bradykinin storms as a possible cause of Covid-19’s pathologies.
I’ve never seen the word “bradykinin” before, and I’m curious if any of the folks here who know medicine can talk more about this, and whether it would be related to possible benefits from anticoagulants and/or statins.
One nice thing, if the what the article speculates proves to be true, is that there are a lot of extant drugs that might help if that’s, indeed, what’s killing people.
The inflammation pathways in the body are quite complex. A lot of the chemicals involved are in the eicosanoid family - thromboxanes, prostaglandins, cyclooxygenase and leukotrienes. (For example, aspirin inhibits thromboxane and other things; some leukotriene inhibitors are used for severe asthma). A lot of the intermediaries are interleukins. Bradykinins are involved in pain chemistry. Most likely all of these chemicals are involved in cases where the immune system, trying to protect from interlopers, basically goes haywire. Cytokines are just signals that can trigger these other reactions. Statins inhibit the manufacture of cholesterol but also acts to reduce other inflammatory markers. Anticoagulants act to inhibit certain blood clotting factors, which are different. Unfortunately, the chemistry is not straightforward.