Login Register Cart 0
Generic placeholder image

Recent Advances in Anti-Infective Drug Discovery

Editor-in-Chief

ISSN (Print): 2772-4344
ISSN (Online): 2772-4352

Back
Journal Home About Journal Editorial Board Current Issue Volumes/Issues
Subscribe
Research Article

Efficacy and Safety of Thrombolysis in COVID-19 Related ARDS

Author(s): Abhishek Goyal*, Yogesh Niwariya, Neeraj Pawar, Alkesh Khurana and Poonam Chaudhary

Volume 18, Issue 3, 2023

Published on: 02 December, 2022

Page: [197 - 204] Pages: 8

DOI: 10.2174/2772434417666221012111042

Price: $65

Abstract

Introduction: COVID-19 causes significant pulmonary microthrombi in some individuals, leading to ARDS and death. Thrombolysis could be an effective approach in some patients with severe ARDS. We describe our experience with the usage of thrombolytic agents in critically ill COVID-19 patients who were in worsening respiratory failure.

Methods: Retrospective chart analysis was done in patients who were thrombolysed between May 2020-Sept 2020. Analysis was done to find out factors associated with improvement in oxygenation and survival.

Results: Twenty-seven patients with severe ARDS [all had respiratory rate >30, FiO2 >0.6 (on NIV/HFNC) and PiO2/FiO2 ratio <120] were thrombolysed in our ICU for COVID19 causes. C.T. Pulmonary Angiography could not be done in any of the 27 patients due to poor general condition, but 2D echo was normal in most (5 had dilated RA, RV), and none of the patients was in shock. So, there was no conventional indication of thrombolysis in these patients, yet after thrombolysis, we observed dramatic changes in oxygenation (defined by a decrease in FiO2 by ≥0.2) in twenty patients. Five patients had a major bleed. Eleven patients survived (survival rate of 40.7%) and the survival rate was high {66% (8/12)} in patients who were thrombolysed within 2 days of oxygen requirement.

Conclusion: In this unprecedented pandemic with high mortality rates, efficacy of early thrombolysis needs to be further explored in randomised controlled trials.

« Previous Next »
[1]
McGonagle D, O’Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol 2020; 2(7): e437-45.
[http://dx.doi.org/10.1016/S2665-9913(20)30121-1] [PMID: 32835247]
[2]
Arachchillage DJ, Stacey A, Akor F, Scotz M, Laffan M. Thrombolysis restores perfusion in COVID‐19 hypoxia. Br J Haematol 2020; 190(5): e270-4.
[http://dx.doi.org/10.1111/bjh.17050] [PMID: 32735730]
[3]
Goyal A, Saigal S, Niwariya Y, Sharma J, Singh P. Successful use of tPA for thrombolysis in COVID related ARDS: A case series. J Thromb Thrombolysis 2020; 51(2): 293-6.
[http://dx.doi.org/10.1007/s11239-020-02208-2] [PMID: 32617806]
[4]
Xie F, Yun H, Bernatsky S, Curtis JR. Brief Report: Risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments. Arthritis Rheumatol 2016; 68(11): 2612-7.
[http://dx.doi.org/10.1002/art.39761] [PMID: 27213279]
[5]
Wichmann D, Obbelode F, Vogel H, et al. Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit: A prospective cohort study. Ann Intern Med 2012; 156(2): 123-30.
[http://dx.doi.org/10.7326/0003-4819-156-2-201201170-00008] [PMID: 22250143]
[6]
Carsana L, Sonzogni A, Nasr A, et al. Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy. Infectious Diseases. HIV AIDS. MedRxiv 20054262.2020;
[http://dx.doi.org/10.1101/2020.04.19.20054262]
[7]
Lax SF, Skok K, Zechner P, et al. Pulmonary arterial thrombosis in COVID-19 with fatal outcome. Ann Intern Med 2020; 173(5): 350-61.
[http://dx.doi.org/10.7326/M20-2566] [PMID: 32422076]
[8]
Richardson S, Hirsch JS, Narasimhan M. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323(20): 2052-9.
[9]
Wright FL, Vogler TO, Moore EE, et al. Fibrinolysis shutdown correlation with thromboembolic events in severe COVID-19 infection. J Am Coll Surg 2020; 231(2): 193-203e1.
[http://dx.doi.org/10.1016/j.jamcollsurg.2020.05.007] [PMID: 32422349]
[10]
Poor HD, Ventetuolo CE, Tolbert T, et al. COVID-19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis. medRxiv 20057125.2020;
[http://dx.doi.org/10.1101/2020.04.17.20057125]
[11]
Wang J, Hajizadeh N, Moore EE, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost 2020; 18(7): 1752-5.
[http://dx.doi.org/10.1111/jth.14828]
[12]
Boersma E, Maas ACP, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet 1996; 348(9030): 771-5.
[http://dx.doi.org/10.1016/S0140-6736(96)02514-7] [PMID: 8813982]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy