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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Bibliographic Details
Published in:Journal of thrombosis and haemostasis Vol. 18; no. 7; pp. 1752 - 1755
Main Authors: 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.
Format: Journal Article
Language:English
Published: England Elsevier Limited 01.07.2020
John Wiley and Sons Inc
Subjects:
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
Online Access:Get full text
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Summary: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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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