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Imo best start is Tech X hands down
Basically any time you'd see a pill, you'll instead see a card so extra joker/chariot/panic warp card chance. Also greater Diamonds/clubs/spades for consumables. If you see blank card it makes it more powerful if you ditch the D4.
If you have it unlocked you might get a chaos card for a difficult boss like hush or get out of jail to unlock mega satan.