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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
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.
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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: Case report / Diagnostic study / Etiology study / Prognostic study / Randomized controlled trials 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

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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: Case report / Diagnostic study / Etiology study / Prognostic study / Randomized controlled trials 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