Heparin prevents blockages in the blood vessels. In addition, it may calm the inflammatory response and even prevent the coronavirus from multiplying. It is now also recommended for bedridden patients in home care.
Helsinki and the Uusimaa Hospital District (Hus) is trying to prevent the severe form of coronary heart disease by recommending anticoagulant medication to bedridden patients over the age of 40 also in home care, in the early stages of the disease.
The prescribing of the drug according to the new recommendation began in Espoo and Vantaa during the Christmas ship week. In Helsinki, the recommendation came into force on Monday. An estimated one hundred patients have had time to receive the medication under the new criteria, says the professor of coagulation diseases Riitta Lassila the Hus Thrombosis Group, which made the recommendation.
As early as spring, low-molecular-weight heparin began to be administered to all hospital patients because excessive blood clotting was revealed to be one of the most dangerous mechanisms of coronary infection. For high-risk patients, the drug was also prescribed for home care.
Heparin treatment given in hospital appears to significantly reduce coronary mortality. According to some studies, hospital mortality has even halved, if the patient has been given anticoagulant medication within two days.
Heparin has been used as an anticoagulant for over 80 years, but it also has other effects that may be relevant to the course of the disease.
Indeed, Hus’s recommendation states that the goal is to reduce the risk of severe disease, not just blockages. The experiment is internationally exceptional.
“If the treatment had such an effect, it would be great news,” Lassila says.
Heparin is the body’s own substance that normally protects the surface of blood vessels and soothes inflammation.
“We assume it could soothe the inflammatory response. Coagulation and inflammation are in constant interaction with each other, ”says Lassila.
On top of all that, new studies have found that it binds to the coronavirus spike protein and reduces viral penetration into cells.
“It has been shown in at least three different laboratories that heparin prevents the invasion of the virus,” Lassila says.
Heparin medication is now recommended for all coronary patients over 60 years of age who are diagnosed, pregnant, and generalized bed patients over 40 years of age.
However, the decision to prescribe a drug is always up to the attending physician. Your doctor should rule out bleeding and other contraindications before prescribing the medicine.
Hus delivers the medicine to the patient free of charge. Guidance is provided on how to inject it. The course lasts at least ten days.
For bedridden patients count those who, because of a fever, cough, or shortness of breath, cannot stand to move. Immobility is in itself a risk factor for blood clots.
“Every step pumps blood forward in the veins. If you can only pawn a few steps to the toilet or eat, there will be no pumping, and this will expose you to blockages, ”Lassila explains.
Coronary heart disease often results in large venous thrombosis that, when initiated, causes fatal pulmonary embolism.
Coronavirus increases clotting by damaging blood vessel walls. Clotting is the first reaction to vascular damage.
There are many small and large vein thrombi in the lungs of coronary arteries. When small blood vessels in the lungs become blocked, oxygen cannot pass from the lungs into the blood or with the blood to other parts of the body. This is one reason for patients ’hypoxia.
The main risk factors for thrombosis and severe coronary heart disease are the same: old age, overweight, and diabetes.
On the screen advocate of urology, professor of urology Kari Tikkinen criticized on Twitter that the recommendation was not based on randomized trials.
In a randomized study, patients are included in the treatment and non-treatment control groups. This provides the most reliable information about the pros and cons of treatment.
Lassila responds to the criticism by saying that in all medical treatment, of course, the best evidence-based means are paramount.
“In this situation, it has been impossible to obtain randomized evidence, and we have to rely on old experience. According to it, early intervention is crucial in all obstructive diseases. ”
There are several randomized trials of heparin in the treatment of patients with pneumonia and bed rest. According to Lassila, 40,000 patients in Finland use heparin as an injection in home care every year due to non-corona, so there is a lot of experience in its use.
Tikkinen says that the results of randomized trials should in any case be awaited before large-scale use of new treatments. He recalls that, for example, hydroxychloroquine was given to large numbers before it proved useless.
At the very least, it should be made clear to patients that the benefit of treatment is uncertain.
“The milder the disease, the less likely it is to benefit from the drug. And when the medicine starts to be injected into the masses, there will be disadvantages, ”says Tikkinen. The disadvantages, in his view, can then be accepted if the benefits have been shown.
Now, the benefit of the extension of treatment, he says, is based on logical reasoning, and the reasoning has often misled.
“Randomized trials are in progress. They show how it is. ”
Early the efficacy of initiated heparin therapy can be assessed by an ex-post study, but can no longer be randomized.
According to Lassila, there is a follow-up of all those who have been diagnosed with covid, on the basis of which it is possible to compare the mortality of those who received heparin medication early and those without it, as well as hospitalization or intensive care. The intention is also to monitor for possible bleeding and patient recovery.
Reduce the risk of jams yourself
■ Drink enough, ie 2 to 2.5 liters of fluid a day.
■ Wear flying socks.
■ Try to walk often.
■ Change posture, move your legs, and avoid sleeping pills.
■ Take your prescribed blood pressure, diabetes and cholesterol medications as directed.
■ Stop smoking.
■ Take care of good oral and dental hygiene.