Dr. Maria da Graca Costa, MD, FACS, Plastic Surgeon, Director of Burn Center, Cristo Redemptor Hospital, Porto Alegre, Brazil, after attending the Heparin Session at the 10th ISBI Congress in Jerusalem Israel, Nov. 1-6, 1998, contacted Dr. Saliba, and started adding heparin to her burn treatment, assisted by Cardiologist Dr. AJ Vercoza MD and Residents S. Alvarez MD and AO Oikawa MD. Redemptor Burn Center.
Dr. Costa continues to do studies and to teach the method in Brazil.
Dr. Costa: Admits and treats 240 burned patients a year, of which 40% are children. Over 2200 patients, age 10 days to 93 years, have been treated with heparin administered topically 4-5 times a day until healed, intravenously initially once a day, and then subcutaneously. Dr. Costa lists benefits of using heparin are improved care, relieved pain without morphine, reduced procedures, reduced mortality, larger size burns can be treated cost-effectively - costs are reduced up to 70%. The necessity to change dressings was reduced and then abolished. Water baths and debridements were not needed. The burns turned dryer, and smaller. Burned tissue flaked off after the fifth day, because the wound was healing under burn crusts, especially with 2nd degree burns. At the 7th Day, the 3rd degree burns were debrided and grafted, reducing the time of hospitalization. "Heparin treatment brings (returns) quality of life to our burned patients!” Dr. Costa presented studies at: - SBI sponsored Int’l Heparin Symposium in Las Vegas Nevada, USA in March 2000, - 6th Int’l Heparin Symposium in the 5th Asian Pacific Burn Congress in Shanghai, in 2004 and - 7th Int’l Heparin Symposium in the 13th ISBI Congress in Fortaleza Brazil, September "Heparin treatment brings (returns) quality of life to our burned patients!”
Dra. Maria da Graca Costa saw the need for and conceived of the method to deliver a standardized measured amount of heparin topically on a burn surface. She met with Cristalia Pharmaceutical Company Medical Director Dr. Jorge Aiune in Sao Paola Brazil, and requested that Cristalia produce a spray bottle containing 50 ml of heparin sodium solution that would deliver 1400 IU of heparin with each single spray. The product was named Alimax.
To promote Alimax use, Dr. Afiune and Dra Graca knew that Brazilian doctors first needed general information about heparin efficacy in treating burned patients. Secondly, studies that specifically tested Alimax heparin in burned patients would need to be performed by Brazilian doctors. They selected, contacted, and arranged studies that would be conducted by the Burn Center Directors in the major hospitals of the 6 largest cities along the Eastern Coast of Brazil. Cristalia adopted, planned, arranged and full financially supported the project.
For the first phase, to disseminate the information, Dra Maria da Graca, requested and obtained the cooperation of SBI and the services of Drs Saliba from the USA and Reyes from Mexico. The policy of SBI was, and remains, that SBI would not endorse any pharmaceutical product, including Alimax. Drs. Saliba,and Reyes were ethically faithful to that principle, presented factual studies, and remained independent and amicable with Cristalia.
Drs. Saliba and Reyes travelled to and within Brazil making heparin presentations; and instructing, and demonstrating use of SBI Heparin Protocol to the doctors, nurses, and staff of the Burn Centers. The cities they visited and the directors with whom they interacted, who subsequently authored new heparin studies were:
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Dra Maria da Graca in Cristo Redemptor Hospital in Porto Alegre;
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Prof. Dra. Maria Cristina Serra in 3 Government Hospitals in Rio di Janeiro;
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Prof Dr. Hamilton and Dr. Flavio Stillitano in Catholic University Hospital in Sao Paolo;
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Dr. Marco Guillherme Barretto in Children Hospital in Recife, and
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Dr. Edmar Maciel in Hospital in Bela Horizonte and for Fortaleza. Dr Maciel was then the President of the Brazilian Burn Society.
Cristalia’s Medical Director Dr. Jorge Afiune sent Dr Ailton Triani to Head the Project; Sales manager Dr. Hugo Praxedes to accompany Drs. Saliba and Reyes; and Sales Production Manager Leonardo Altobelli Jr. to intermittently meet with them.
The subsequent studies (summaries below) by Brazilian doctors using Alimax Heparin generated good results for publications and presentations by the authors inside Brazil and in other countries (in Website Paraguay, South Africa, the United States, Chile, and Ecuador).
Summary of 2 Studies with Controls:
(1) 20 patients treated with heparin (H) were compared to 20 Control (C) cohort patients not treated with heparin; and (2) Another study of 20 H patients were compared with 22 C patients given Traditional Care without Heparin. Patients with a contraindication to heparin, or with diabetes, epilepsy, and/or alcoholism, were excluded. Treated H patients received heparin intravenously for the first 48 hours, subcutaneously twice a day for 3 days, and topically 3-4 daily from onset into final healing. Results. Control patients (C) without heparin required pain medicine every 4 hours. Heparin treated (H) needed none. Inflammation abated in H, persisted in C. In H, a total 5 anesthetics and operations in 20pts, av 0.2/pt, were significantly less compared to C (100% of C had 2.5 av ops/ pt). Baths with removal of burned tissue (debridements) were discontinued in H, but needed and used in C. In H, Blood Transfusions, 4 total in 20pts ( 20%) of 390 ml average per transfusion, were significantly less than in C, 13 in 22pts (59.9%), of 1,642 ml of blood/pt av. Days in Hospital was 16.5 av in H, and 21 Days av in C. The postburn days to reepithelialize the burns (new skin) was 16.5 day in H, and 21 days in C. The new skin in H was remarkably smoother with less contracture and less scar. The cost in H was 70% less than C. All of these improvements resulted in a sense of well-being in patients, especially children and their mother.
(Left) Dr Jorge Veracoza MD who manages clinical use of Heparin in burns
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