The characteristics and outcomes of critically ill patients with COVID-19 who received systemic thrombolysis forpresumed pulmonary embolism: An observational study
Research and Practice in Thrombosis and Haemostasis
; 5(SUPPL 2), 2021.
Article
in English
| EMBASE | ID: covidwho-1509120
ABSTRACT
Background:
Coronavirus disease 2019 (COVID-19) is associated with abnormal hemostasis, autopsy evidence of systemic microthrombosis, and a high prevalence of venous thromboembolic disease (VTE). Tissue plasminogen activator (tPA) has been used in COVID-19 patients with severe hypoxia with high clinical suspicion of pulmonary embolism (PE).Aims:
We aimed to describe the clinical outcomes of critically ill COVID-19 patients who received tPA.Methods:
A retrospective cohort study was conducted on 6,095 hospitalized COVID-19 patients in the Mount Sinai Health System at 5 hospitals in New York. 57 patients with COVID-19, who were admitted from 3/10 to 4/27, 2020 and received tPA for presumed PE were included in the analysis. Baseline demographic and clinical characteristics, indication for tPA, and overall mortality were reported.Results:
Among the 57 patients who received tPA, the mean age was 60.8 ± 10.8 years, and 71.9% (41/57) were male. PE was suspected among 75.4% (43/57) of patients with supporting findings who had rapidly worsening hypoxia or hypotension. Right ventricular (RV) strain was present in 15.8% (9/57), deep venous thrombosis (DVT) in 7.0% (4/57), increased dead space ventilation (V d ) in 31.6% (18/57) of patients. RV strain and RV thrombus were present in 3.5% (2/57), RV strain and DVT in 5.3% (3/57), RV strain and increased V d in 8.8% (5/57), and DVT and increased V d in 3.5% (2/57) of patients. No chest CT angiography was performed for any patients due to clinical instability from critical illness. Following tPA infusion, 49.1% (28/57) of patients demonstrated improvement in either of PaO 2 /FiO 2 ratio, blood pressure or partial arterial carbon dioxide. Bleeding complication was seen in 1 patient. Six patients (10.5%) survived to hospital discharge. Overall mortality was 89.5% (51/57).Conclusions:
The overall mortality of critically ill COVID-19 patients who received tPA for presumed PE was 89.5 %. The utility of tPA for this indicaition warrants further studies.
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Observational study
/
Prognostic study
Language:
English
Journal:
Research and Practice in Thrombosis and Haemostasis
Year:
2021
Document Type:
Article
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