Saved by blood
A method for preventing the growth of blood clots in COVID-19 has been found
Natalia Mikhalchenko, Izvestia
At once in 11 Moscow clinics, including the 40th hospital in Kommunarka and the N.V.Sklifosovsky Research Institute of Emergency Medicine, a method for predicting the rate of blood clots formation in severe COVID-19 is being studied. Explosive thrombosis, leading to heart attacks and strokes, turned out to be one of the most dangerous consequences of exposure to the new coronavirus on the body. With the help of the device "Thrombodynamics Recorder", scientists plan to determine the necessary doses of anticoagulants (blood thinning drugs) and promptly change them depending on the severity of the patient's condition. The aim of the study is to develop a new COVID-19 treatment protocol that would reduce the number of deaths.
Reduce risks
The new coronavirus damages the endothelium, the layer of cells lining the inner surface of blood vessels, which causes increased thrombosis. This is one of the most dangerous consequences of exposure to SARS-Cov-2 on the body, along with the "cytokine storm".
– Autopsies of patients who died from COVID-19 showed that in 90% of cases their lungs were clogged with blood clots, – Fazli Ataullakhanov, corresponding member of the Russian Academy of Sciences, Professor of Lomonosov Moscow State University, told Izvestia. – Our research is aimed at reducing mortality from coronavirus.
As the scientist noted, about a month ago, the Ministry of Health of the Russian Federation introduced a preventive dose of heparin, a drug that sharply reduces the activity of blood clotting, into the treatment protocol for all patients admitted to hospitals with COVID-19.
– Our studies have shown that a preventive dose of heparin helps well in 70% of cases. But for 20% of patients it is insufficient, and for 10% it is excessive – such patients are at risk of bleeding. The doctor sees that the patient's condition continues to deteriorate, and increases the dose of heparin at his own risk," the expert commented.
The device "Thrombodynamics Recorder", according to him, allows you to make this process controlled and safe.
– The device was created 10 years ago for the diagnosis of hemostasis (the body's system that maintains the liquid state of blood, is responsible for stopping bleeding and dissolving blood clots that have fulfilled their function – Izvestia), prevention and treatment of heart attacks, strokes, deep vein thrombosis and pulmonary embolism, – Ilya Spiridonov, General Director of Izvestia, explained director of the GemaKor company, which produces the device.
If patients with COVID-19 regularly monitor the state of blood clotting with this device, then you can fight thrombosis not blindly, but by precisely adjusting the dose of the anticoagulant, depending on the characteristics of the body.
Within the limits of the norm
One of the properties of our blood is the ability to clot in a timely manner, that is, to form a clot – a blood clot to stop bleeding. If this mechanism is broken, the folding system does not work correctly. By examining hundreds of healthy people, the scientific group of Fazli Ataullakhanov determined the limits of the norm of the rate of thrombosis. As the professor notes, it should be in the range of 20 to 30 microns per minute. If this speed is 31-32 microns per minute, it is already worth being wary. 40 instead of 30 is a very serious violation. In the case when this figure exceeds 50 microns, it is necessary to act immediately, otherwise the patient will definitely get thrombosis.
– At this rate, blood clots begin to grow not only in places of vascular damage, but everywhere. Spontaneous clots appear anywhere, and the risk of severe consequences is very high," Fazli Ataullakhanov told Izvestia.
When the capillaries of the lungs are clogged with blood clots, the tissues receive neither nutrition, oxygen, nor medications. But bacteria multiply, which are always present in the body. With COVID-19, it turned out that even in patients who are brought to the hospital in a relatively light condition, the blood clotting system is often in a hyperactive state, that is, it is prone to give thrombosis. This can only be tracked by laboratory tests, the process can remain invisible for a long time externally.
– It can be assumed that people with a physiologically higher level of blood clotting are more susceptible to a severe form of the disease. Therefore, with hemodynamic disorders in patients with coronavirus infection, there is an obvious need for urgent actions on the part of physicians to prevent thrombosis, – said Alla Zagainova, Candidate of Biological Sciences, Associate Professor of the Department of Anatomy and Physiology of Humans and Animals of TSU.
New protocol
The study involved patients from eleven Moscow clinics. Among them are the 40th hospital in Kommunarka, the N.V. Sklifosovsky Research Institute of Emergency Medicine, the 23rd, 51st, 52nd, 64th hospitals, the clinic of the Academy of Sciences in Troitsk near Moscow.
Blood tests are taken from patients once a day and the process of thrombosis is visualized. About 800 patients are covered by such monitoring. The first, observational phase of the study, will be completed at the end of June. In the second, scientists will offer options for the dosage of anticoagulants depending on the rate of blood clots in specific patients.
– We are participating in the study to save as many lives of our patients as possible. Contribution to science in this case is a nice bonus," Sergey Tsarenko, Deputy Chief Physician for Anesthesiology and Intensive Care at Moscow Hospital No. 52, told Izvestia. – So far we have just started, but we have already clarified some of the subtleties of hemostasis correction in a severe group of patients on ECMO (devices for blood oxygen saturation in the development of acute respiratory failure – Izvestia).
The result of the research will be to determine the significance of the thrombosis rate factor in the severity of the disease and the survival rate of COVID-19 patients. The group studies the state of hemostasis in conjunction with all other significant parameters of the patient's condition, including data on blood oxygen saturation, CT readings recording the percentage of lung damage, the state of the immune system, temperature, pressure, etc.
Already, the rate of thrombosis is recognized as one of the most significant indicators for predicting the outcome of the disease. The study will allow us to draw statistically reliable conclusions and propose a new protocol for the treatment of COVID-19 patients.
This technique for visualizing the growth of a clot (thrombus) is patented both in Russia and in Europe, the USA and China. To study hemostasis in COVID-19, HemaCor provided its devices for free. If the method is recommended for widespread use in clinics where coronavirus patients are treated, the company will be able to produce up to a thousand devices by the end of the year.
Now new modifications of the device and tests for it have been developed, allowing to visualize not only the growth of a clot, but also fibrinolysis – the dissolution of a blood clot, as well as the generation of thrombin – a key element of the hemostasis system. So far, only scientists in university clinics around the world are working with these novelties, they have not yet been introduced into practice.
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