re: SARS-CoV-2/COVID-19 medical pro thread...

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Any benefits of anticoagulation in positive Covid 19 cases beyond prophylactic dose of lovenox/heparin for DVT prophylaxis? Heparin drip, treatment dose lovenox, DOAC/NOAC?

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Yes.

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The thrombotic events may be due to a DIC type picture we see in these patients from the massive inflammatory response. I don’t think anyone has trialed anticoagulants, although Ochsner Nola now gives all of these patients statins, which have some antiplatelet and anti inflammatory effects. Some people have speculated that the sudden crash some of these patients take is due to a pulmonary embolism but I don’t know if that’s been supported by postmortem pathology.

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The statin debate is interesting and I know there are folks out there advocating using D-Dimer >2000 as a benchmark for full dose heparin. Do you know with the statin administration if that is something they carryover from typical ARDS experience or they are doing it specific to these patient?

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I'm talking about stuff like what type of non-invasive ventilation you're using, when you're intubating (early or later and the debate on the two strategies). ARDSnet protocols and whether for most people this is really behaving like normal ARDS and thus what vent modes and strategies are being used. This is only the tip of the iceberg, I'm just trying to get the ball rolling.

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I think it’s more successful to treat with early intubation. You want to hit this thing head on. Before you know it, bronchioles swell, esophagus is lined with hardened mucus, membranes don’t breathe properly, and the lining of the lungs is infected beyond repair.

My recent experiences show that the experimental drug Sartiphexis is effective, but those results have not been published. Of course, there have been a limited number of clinicals. Sartiphexis works because of the high number of Ambuprephins. This no doubt kills the Extreniant growth in the virus. Once that is done and the Fermiotites dissipate toward a healthy number, the body takes over with natural antibodies.

Hope this helps

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only wasted 5 minutest typing this out.

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If it took you 5 mins to type that smidgen of info you really should consider being a book editor

Did anyone read the preprint on inhibiting heme metabolism (Liu, et. al)? The Emergency Medicine/Critical Care Podcast FOAMcast (now Covidcast) mentioned the paper in the discussion of the clinical similarities between COVID-19 related pulmonic dysfunction and high altitude pulmonary edema. It is out of China and highly technical and a bit difficult to get to, but the premise is interesting. Shows how novel this thing really is and underscores the attendant problems of a new disease entity. COVIDcast (Jeremy Faust/Lauren Westafer - apple or spotify) is a great way to keep up with what others are trying and what is falling in and out of favor in this dynamic situation.

Preprint: Liu et al (COVID-19/Hgb attack/porphyrin capture