Tissue plasminogen activator (tPA) treatment for COVID‐19 associated acute respiratory distress syndrome (ARDS): A case series

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 consistent...

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Vydané v:	Journal of thrombosis and haemostasis Ročník 18; číslo 7; s. 1752 - 1755
Hlavní autori:	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.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England Elsevier Limited 01.07.2020 John Wiley and Sons Inc
Predmet:	acute respiratory distress syndrome (ARDS) Aged Alveoli Autopsy Betacoronavirus - pathogenicity Blood Coagulation Disorders - blood Blood Coagulation Disorders - diagnosis Blood Coagulation Disorders - drug therapy Blood Coagulation Disorders - virology Case Report Case reports Coronavirus Infections - blood Coronavirus Infections - diagnosis Coronavirus Infections - drug therapy Coronavirus Infections - virology COVID-19 Etiology Fatal Outcome Female Fibrin fibrinolysis Fibrinolysis - drug effects Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Host-Pathogen Interactions Humans Male Mechanical ventilation Middle Aged Mortality Oxygenation Pandemics Patients Pneumonia, Viral - blood Pneumonia, Viral - diagnosis Pneumonia, Viral - drug therapy Pneumonia, Viral - virology Recovery of Function Respiratory distress syndrome Respiratory failure Respiratory therapy SARS-CoV-2 t-Plasminogen activator Thrombolytic drugs Thrombolytic Therapy - adverse effects THROMBOSIS tissue plasminogen activator (tPA) Tissue Plasminogen Activator - administration & dosage Tissue Plasminogen Activator - adverse effects Treatment Outcome COVID-19 fibrinolysis tissue plasminogen activator (tPA) case report acute respiratory distress syndrome (ARDS)
ISSN:	1538-7933, 1538-7836, 1538-7836
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Shrnutí:	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.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Case Study-2 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Janice Wang and Negin Hajizadeh are co‐first authors. Final decision: David Lillicrap and 04‐Apr‐2020 Manuscript handled by: David Lillicrap
ISSN:	1538-7933 1538-7836 1538-7836
DOI:	10.1111/jth.14828