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Photomontage: Cleber Siquette / Jornal da USP
The use of the anticoagulant heparin improved the functioning of the lungs and blood oxygenation in patients with severe cases of covid-19 undergoing treatment at the Sírio-Libanês Hospital in São Paulo, with the participation of doctors from the Faculty of Medicine of the USP (FMUSP). Heparin reversed blockages in the organ’s blood vessels, improving respiration and bringing oxygen to the blood. With the improvement, patients were able to stop using mechanical ventilation and leave the Intensive Care Unit (ICU) of the hospital.
The results are described in an article published on the Medrxiv website on April 22. The idea of the treatment came up in March, after the follow-up of the first covid-19 patient admitted to the ICU of Sírio-Libanês, who had cyanosis of the extremities (blue fingertips) and a sudden drop in blood oxygenation . “Although the lung normally blew air, oxygen did not enter the bloodstream,” reports pulmonologist Elnara Negri, a professor at the USP School of Medicine (FMUSP), who coordinates the study.
Progressive improvement
From the analysis of this and other cases, it was hypothesized that there was an image of intravascular coagulation in the lungs, in reaction to the inflammatory storm caused by the virus, preventing oxygen from reaching the blood.
“As the patient already showed signs of skin thrombosis, an anticoagulant was indicated and within eight hours there is an improvement in oxygenation, causing the fingers to return to their normal color. This patient was discharged and has already returned home, “says Elnara.
The doctor decided to contact the doctors at the Hospital das Clínicas (HC) of FMUSP who performed an autopsy on people who died of covid-19, verifying that they had a large number of thrombi in the pulmonary microcirculation, confirming the initial hypothesis. “Heparin is widely used in the treatment of thrombotic phenomena in clinical practice,” he says. “The patients were treated after the onset of respiratory failure and progressively improved, whether or not they needed mechanical ventilation.”
Heparin is applied in severe cases that progress to a decrease in blood oxygenation. “This initial study includes 27 patients with Covid-19 with a WHO score of 3 to 7, an indicator of the severity of the disease established by the World Health Organization (WHO), mean age of 56 years, comorbidities such as diabetes , obesity and heart disease, among others, “says Elnara. “The patients had an average hospital stay of around 10 to 15 days and they are all alive. Most have already been discharged and only three remain in the ICU. ”
According to the doctor, heparin treatment is affordable and is already used in the Unified Health System (SUS), which can make it available to a large number of people. “It is contraindicated for patients at high risk of bleeding, such as those who have some tumor lesions, who recently had a stroke or had recent surgery,” he notes.
The researchers intend to consolidate the results obtained in the treatments using different heparin doses in a larger number of patients. “At a later stage, a study will be conducted in patients who are in the pre-ICU stage, who will receive anticoagulants early to avoid intubation and the use of a mechanical ventilator,” Elnara plans.
The investigation will begin after approval by the National Council for Research Ethics (Conep). “The treatment is for the complications that the virus brings to the body, aimed at patients in a more serious condition,” says the doctor. “Prevention and cure of the disease will only come with the development of vaccines and antiviral drugs.”
The preliminary results of the treatment were published in the form of a prepress, to inform and guide other doctors and academics in Brazil and abroad. The work is based on the collaboration of doctors in the areas of pulmonology, hematology and intensive care from Sírio-Libanês, researchers from the Laboratory of Cell Biology (LIM-59) and from the Department of Hematology and Hemotherapy at FMUSP, Instituto do Coração do HC and AC Camargo Cancer Center.
The doctor comments that it is possible that the thrombosis observed in the pulmonary microcirculation is related to cases of stroke in young patients with covid-19, as reported in the United States. “The hypercoagulability status of these patients has been increasingly verified in various situations,” he says.
Text by Jornal da USP
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