Looks to be a British analysis of Swedish data with an assist from 6 Swedes from 6 institutions, including the estimable Pär Stattin.
The paper begins: "Existing literature examining warfarin's association with prostate cancer (PCa) risk provides conflicting results ..."
Excuse the preamble, but the subject needs an intro. In a screened population, PCa is detected before symptoms occur. Even so, there are studies that found that a DVT or pulmonary embolism increases one's risk of a cancer diagnosis within so many months. i.e. abnormal coagulation can be an early sign of PCa. Cancer is associated with coagulation dysregulation & it can be an early event.
Some researchers have hypothesized that abnormal coagulation may be a necessary condition for metastasis. A tumor can shed large numbers of cells into the circulation each day, but the body is very good at zapping them. However, if a cell docks with a micro-clot it can become 'invisible' and protected.
So, if a man begins Warfarin long before PCa develops, he may have a reduced risk of metastatic disease. Conversely, if PCa has already developed, undetected, Warfarin use may appear to be a risk factor for PCa itself. My 2 cents.
It's a big study: "Among 31,591 cases and 156,802 controls, there were 18,522 (9.8%) warfarin and 4,455 (2.4%) DOAC {direct oral anticoagulants} users."
"Warfarin ever-use was associated with {8%} reduced risk of PCa overall ... as were both past and current use.
"DOAC use was not associated with PCa risk.
"For some warfarin exposures, decreased risk was observed for unfavorable PCa (high risk/locally advanced/distant metastatic) but not with favorable PCa (low/intermediate risk).
A 39% "Increased risk of favorable PCa was observed for men whose initial warfarin exposure occurred in the 12 month period before diagnosis ..."
So, Warfarin, unlike the other anticoagulants, might actually inhibit PCa development. Particulary if started at least a year earlier.
And, there does seem to be protection against mets. This is why some of us monitor D-dimer & use nattokinase to break down the fibrin that forms a clot. I do it even though I have mets. The last thing I need is an increased cancer burden throughout my skeleton. Also, I never want to be on Warfarin again.
The 39% increase in 'favorable' PCa following the recent initiation of Warfarin might be partly due to detection bias following a coagulation crisis, but I don't know what the follow-up protocol is in Sweden.
I do not use low-dose aspirin - with my luck I'd be one of those who get stomach bleeding or kidney damage. Aspirin is responsible for numerous ER visits, & unless one has already had a CVD event, it will not protect against a future event. In fact, for the majority of users in the US there is a downside with no upside.
Having said that, low-dose aspirin is excellent for preventing platelet aggregation - the first step in forming a clot. For those who are using it without issues, why not continue? One should still monitor D-dimer though.
You ask "might we be risking a bleeding event?" Only with aspirin.
I've been taking low dose aspirin for a very long time, to ward off the risk of stroke during an atrial fibrillation episode. I've recently had a-fib ablation surgery but continue my low dose aspirin use. I also take K2/nattokinase. I wonder if aspirin would have any benefit should I become exposed to covid.
A blood clot in my leg was the first indication that something was wrong. My GP and Onco ordered a full body CT which showed nothing, so they sent me home with a clean bill of health. On my own, I paid for a liquid biopsy which identified the PCa. A subsequent mpMRI followed by a biopsy confirmed the PCa diagnosis. I've had two more blood clots over the past 4 years so I'm now on low dose Xarelto.
It is a well established fact that cancer is a HYPERCOAGULABLE state. Means there is increased tendency to form clots in blood vessels. If more clots are formed, more of them will break away and become thrombi and with blood circulation will move and block a vessel in a vital organ. If they lodge in heart vessels, it causes heart attack..if in lung...it causes pulmonary embolism and if in brain..it causes stroke.
When cancer is present in our body, the number of platelets increase dramatically and reach in range of 400 to 1000 thousand platelets. Many of these platelets start clumping together. Many of them stick to cancer cells and hide them from Phagocytes and NK cells.
In this way, cancer cells are protected and they circulate and cause more and more metastases.
But in order to deal with risk of clots , we do not have to be on warfarin . Warfarin requires a lot of monitoring and can be dangerous if dose is not correct.
The simpler, safer and effective way to reduce coagulable state is to eat blood thinning foods such as turmeric, Ginger, Onions, Garlic , Coriander, Parsley, Rosemary, Oragano, Holy Basil etc. ...and of course some Nattokinase what Patrick takes. Also, keep ourselves well hydrated with clean drinking water and keep moving our limbs every 2 hours.
With Good Wishes.
(This is not a medical advice...it is only factual information)
"turmeric, Ginger, Onions, Garlic , Coriander, Parsley, Rosemary, Oragano, Holy Basil" I have been eating and supplementing with them along with Vitamin C ever since diagnosis -- AND I had big bruises (black and blue and purple spots on arms or legs ) at the slightest bump -- I backed off the C --- and have stopped almost all bleeding or bruising unless really hit hard ... I never had a problem with continued bleeding from cuts -- but sometimes when blood drawn I would have a big purple spot 3 or 4 inches ... that has since stopped too. Anyway I wonder if Vitamin C with the other aforementioned foods and suppl. would work as well as Nattokinase -
You started having easy bruising after using a lot of these blood thinning herbs. ...And that is the most obvious proof that they have effective anti-coagulation activity.
In your situation, the best thing to do is to reduce the amounts of each of these herbs to half and bruising will stop. Too much of good thing can become bad too.
I have naturally low platelet counts - usually 140 or below, despite the vitamin K2 I take. I bruise crazily, sometimes from a slight bump and sometimes from nothing at all, and like George71 am usually spotted on forearms and lower legs with big purple bruises - and bleed profusely from the smallest cuts, ended up in the ER more than once from blood loss in what would be innocuous injuries in most people. I was told to take low-dose aspirin for my heart, but the bleeding and bruising got out of control and I had to stop (same thing with naproxen and ibuprofen). I take 500mg of time-release ester-C daily (didn't know it was anti-clotting), don't eat most of those suspect herbs, though I like garlic, maybe a clove a day at most with meals. And of course I have PC, but at this point no mets.
Kapakahi, Just like you ,some people have naturally low platelets. That's why normal range is from 140,000 to 320,000.
From Prostate cancer prognosis point ,having lower platelets is a good thing. (should not go lower than 50000 because risk of bleeding goes up significantly.
Low platelets like 120- 160 thousand is great as platelet-lymphocyte Ratio goes down. .indicating longer life. PLR should remain below 100.
BTW, If your platelets dip below 100,000, there is a simple solution...I take 3 papaya leaves ,cut and boil them in a glass of water.. drink small amount of this water 3 to 4 times a day for 5 days. Platelet counts will bounce back higher than 100000 within a week. Doctors give prednisolone for raising platelets but it has much more side effects than papaya leaf water.
I never see the PLR singled out in my CBCs - but in my last one, platelets were 164 (high for me) and lymphocytes 1.0, so a ratio of 164.
Of course this created a new obsession for me, looking up ratios of platelet-lymphocyte, neutrophil-lymphocyte/NLR and lymphocyte-monocyte/LMR and also mean platelet volume/MPV, all of which are said to bear on progression and survivability of a range of common diseases. Several of the CBCs didn't include one or more of the counts, none included any of these ratios. My lymphocytes were always around 0.8 - 1.0, so any platelet count in the normal range is going to result in a PLR way above 100.
I just looked at two studies' attempts to nail down reference ranges for all of these - it seems they haven't really been established all that well, and they can also vary by race and age. And disease (none of the studies included PC). All of my counts are in the normal range, yet some of the ratios between them are associated with inflammation and outcome. How is it possible for normal values of different factors to be associated with better or worse outcomes? It seems that normal values would mean normal ratios (whatever "normal ratios" even are).
The thing is, most of my blood tests have not included one or more of the different counts, and none have included ratios, so it seems the average PCP either isn't up to speed on these things or isn't concerned as long as the basic counts are OK.
IOW, arrgghhh!!! I don't think I should stress about this. Cancer, covid and politics is way more than enough right now. [;-}
Kapa...no need to stress about these ratios. Lab will not calculate these for you so you will have to do it yourself from your blood count results.' Its very easy.
NLR = Absolute Neutrophil count divided by absolute Lymphocytes.
PLR= Total platelet count divided by absolute lymphocyte count.
LMR = Absolute Lymphocytes divided by Absolute Monocytes.
NOTE: NLR should be below 3, LMR should be above 3 and PLR should be below 100.
e.g My platelet count is 147,000 and Lymphocyte count is 2100.
therefore....147000 divided by 2100 is equal to 70 (So PLR=70)
Primary doctors do not have time to go in such details.
I knew how to do the math - it's the reference ranges I couldn't find. If the ratios are important, why don't labs calculate them and provide the ranges? And if PCPs don't have time for those details, I'd think they would check the ratios and, if they're not good, refer you to some kind of specialist for further investigation.
From what you say here for those three ratios, I'm not in great shape: NLR 3.2, LMR 2.0, PLR 164 - and all due to my low-normal lymphocytes (my WBC always is also on the low end of normal). I'm doomed!
No. You are not doomed. You are more informed now and smarter . You know that lymphocytes are lower than what you would like. So now, its possible to acquire knowledge how to boost your lymphocytes. You got a talking point with your doctors to advice you about your lower lymphocyte count. Just to share with you...On Jan2020 ,I took a dose of live, attenuated Cholera Vaccine called Vaxchora and my lymphocytes went up by 120% bringing all my ratios in good place. I took the vaccine as Nalacrats pointed out to us a Swedish Study about benefits of Cholera vaccine in PCA people. Please ask your doctors ways to keep lymphocyte counts good. I do not mean to make you anxious. The most important Ratio. .NLR is still good..it is still close to 3.0. That is good news.
Thanks. By "doomed" I kind of mostly really probably possibly hopefully meant existential, which is the human condition. But it was unsettling to LearnAll this. (I do have to find another PCP - when my triglycerides doubled (no change in diet) and my TSH rose 50% in about six months, both way above normal and way unprecedented for me, he wrote "stable and acceptable" on the lab report and later told me triglycerides wouldn't need medication until they went over 500.) The good thing is that I rarely get sick and I get plenty of all the foods and supplements said to increase WBC levels, and still it's barely above the lowest level. But neutrophils and monocytes are right in the middle of normal, so I guess that's good enough.
An average type of primary doctors office is like McDonalds .....a good primary doctor's office is like Fine Dining Restaurant. In first one, its just bare minimum care and in second ..the quality and details matter a lot. That is why we have to be knowledgeable and proactive about our health care.
Lower Neutrophils, Higher Lymphocytes and lower platelets are what is desirable.
In addition to Nattokinase, another possibility might be Lumbrokinase. Derived from intestinal walls of earthworms it's been used for thousands of years in Chinese medicine. Recently it's use has been explored in heart disease.
Interesting point for PCa is that in the above heart related study, the authors spell out the Cox-2, MMP-9, JNK inhibitory effects of lumbrokinase, upregulation of all of these pathways have been implicated also in PCa progression.
In a comprehensive look a Covid from an herbalist's perspective (well worth a look), Lumbrokinase is mentioned as an anti clotting agent that is "30 times stronger than Nattokinase" pg. 27,
Serrapeptase is also a blood thinner. I interleave, on a daily basis, Serrapeptase with 100mg Aspirin before going to bed, because I read that the combination is considered too much. On top of that a Nattokinase capsule at 4-6 AM when I visit the bathroom. My latest D-DIMMER was 0.348 μg FEU/ml (normal values 0-0.5). It seems there is more room for improvement. Pjoshea likes it further down.
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Cancer and stress: not directly related to prostate cancer but interesting research
Major Prostate Cancer Breakthrough
Testosterone Levels and Prostate Cancer Risk - 1
EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer 2020
