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Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series.
Wang, Janice; Hajizadeh, Negin; Moore, Ernest E; McIntyre, Robert C; Moore, Peter K; Veress, Livia A; Yaffe, Michael B; Moore, Hunter B; Barrett, Christopher D.
  • Wang J; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
  • Hajizadeh N; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
  • Moore EE; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA.
  • McIntyre RC; Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
  • Moore PK; Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
  • Veress LA; Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
  • Yaffe MB; Department of Pediatrics, Pulmonary Medicine, University of Colorado Denver, Aurora, CO, USA.
  • Moore HB; Center for Precision Cancer Medicine, Departments of Biological Engineering and Biology, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
  • Barrett CD; Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Thromb Haemost ; 18(7): 1752-1755, 2020 07.
Article in English | MEDLINE | ID: covidwho-1317980
Semantic information from SemMedBD (by NLM)
1. alteplase TREATS Respiratory Distress Syndrom
Subject
alteplase
Predicate
TREATS
Object
Respiratory Distress Syndrom
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Blood Coagulation Disorders PROCESS_OF Patients
Subject
Blood Coagulation Disorders
Predicate
PROCESS_OF
Object
Patients
4. Respiratory Distress Syndrom PROCESS_OF C0030705
Subject
Respiratory Distress Syndrom
Predicate
PROCESS_OF
Object
C0030705
5. Lung LOCATION_OF Microthrombus
Subject
Lung
Predicate
LOCATION_OF
Object
Microthrombus
6. Autopsy CAUSES Vascular occlusion
Subject
Autopsy
Predicate
CAUSES
Object
Vascular occlusion
7. Compliance COEXISTS_WITH Respiratory Distress Syndrom
Subject
Compliance
Predicate
COEXISTS_WITH
Object
Respiratory Distress Syndrom
8. alteplase TREATS Respiratory Failure
Subject
alteplase
Predicate
TREATS
Object
Respiratory Failure
9. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
10. Respiratory Status PROCESS_OF Patients
Subject
Respiratory Status
Predicate
PROCESS_OF
Object
Patients
11. alteplase TREATS Respiratory Distress Syndrome, Adult
Subject
alteplase
Predicate
TREATS
Object
Respiratory Distress Syndrome, Adult
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
13. Blood Coagulation Disorders PROCESS_OF Patients
Subject
Blood Coagulation Disorders
Predicate
PROCESS_OF
Object
Patients
14. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
Subject
Respiratory Distress Syndrome, Adult
Predicate
PROCESS_OF
Object
Patients
15. Lung LOCATION_OF Microthrombus
Subject
Lung
Predicate
LOCATION_OF
Object
Microthrombus
16. Autopsy CAUSES Vascular occlusion
Subject
Autopsy
Predicate
CAUSES
Object
Vascular occlusion
17. Compliance COEXISTS_WITH Respiratory Distress Syndrome, Adult
Subject
Compliance
Predicate
COEXISTS_WITH
Object
Respiratory Distress Syndrome, Adult
18. alteplase TREATS Respiratory Failure
Subject
alteplase
Predicate
TREATS
Object
Respiratory Failure
19. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
20. Respiratory Status PROCESS_OF Patients
Subject
Respiratory Status
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
A prothrombotic coagulopathy is commonly found in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS). A unique feature of COVID-19 respiratory failure is a relatively preserved lung compliance and high Alveolar-arterial oxygen gradient, with pathology reports consistently demonstrating diffuse pulmonary microthrombi on autopsy, all consistent with a vascular occlusive etiology of respiratory failure rather than the more classic findings of low-compliance in ARDS. The COVID-19 pandemic is overwhelming the world's medical care capacity with unprecedented needs for mechanical ventilators and high rates of mortality once patients progress to needing mechanical ventilation, and in many environments including in parts of the United States the medical capacity is being exhausted. Fibrinolytic therapy has previously been used in a Phase 1 clinical trial that led to reduced mortality and marked improvements in oxygenation. Here we report a series of three patients with severe COVID-19 respiratory failure who were treated with tissue plasminogen activator. All three patients had a temporally related improvement in their respiratory status, with one of them being a durable response.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Blood Coagulation Disorders / Thrombolytic Therapy / Tissue Plasminogen Activator / Coronavirus Infections / Fibrinolysis / Fibrinolytic Agents / Betacoronavirus Type of study: Diagnostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: Jth.14828

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Blood Coagulation Disorders / Thrombolytic Therapy / Tissue Plasminogen Activator / Coronavirus Infections / Fibrinolysis / Fibrinolytic Agents / Betacoronavirus Type of study: Diagnostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2020 Document Type: Article Affiliation country: Jth.14828