The hypothesis that caused by COVID-19 blood clots diseases may reveal some of the worst signs of COVID, including respiratory collapse and pulmonary fibrosis, was suggested in mid-April by investigators in Brazil affiliated with the University of São Paulo’s Medical School (FM-USP) via an article received for publication by the Journal of Thrombosis.
In less than a month, the topic of Science and Nature was highlighted in studies on the websites of Science and Nature, both of which are among the world’s driving scientific publications.
The Research Case
One of the first investigators to report the “thrombotic type” of the infection created by the novel coronavirus (SARS-CoV-2) was Elnara Negri, a researcher and pulmonologist at Hospital das Clínicas, the clinic system run by FM-USP – the largest in Latin America – and Hospital Sírio-Libanês, a leading private clinic also in São Paulo City.
“Around March 25, we were managing a patient whose breathing was quickly declining,” Negri told Agência FAPESP.
“When she was intubated, I noticed that her lungs were clear to cool. They weren’t set and stiff, as you’d anticipate in someone with acute respiratory irritation. Soon after that, I remarked that the patient had an ischemic toe.”
The latter form has been assigned to as COVID-toe and can change all ten toes. It is caused by the obstruction of the tiny blood vessels that circulate blood in the extremities.
Negri saw a similar phenomenon several years ago in sufferers who underwent open-heart surgery with extracorporeal circulation.
“In the old days, a device was applied to draw oxygen into the blood, and clots would form inside the blood vessels. I’d seen the situation before and knew how to treat it,” she replied.
COVID-19 The Blood Clots Treatment
Negri directed heparin, one of the most extensively used anticoagulant medications worldwide. In under 18 hours, the patient’s oxygen congestion improved, and her angry red toe recovered a healthy pink color.
Most researches show severe COVID-19 patients require 28 days of mechanical ventilation on average, whereas those employed with heparin typically occur after intense care of ten to 14 days.
An article by Negri and colleagues describing their clinical experience with the first 27 patients treated with the protocol developed at Sírio-Libanês is free on medRxiv as a preprint (not yet peer-reviewed) version.
The Invasive Procedure
Soon after the first strong administration of heparin, Negri shared the finding with partners Marisa Dolhnikoff and PauloSaldiva, pathologists at FM-USP who are coordinating the autopsies of sufferers who die from COVID-19 at Hospital das Clínicas.
Using a minimally invasive procedure developed during a project supported by FAPESP, the pathologists saw focal bleeding associated with mini-clots (microthrombi) in the lungs’ tiny blood vessels due to platelet clumping.
Negri, Dolhnikoff, Saldiva, and colleagues recently wrote to the editor of the Journal of Thrombosis and Haemostasis, explaining their findings. Entitled “Pathological evidence of pulmonary thrombotic phenomena in critical COVID-19“, this is the first article in the experimental literature to report this topic. The study could potentially revolutionize the treatment of the condition. It was fully peer-reviewed and admitted for publication by the journal.