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Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series.
J Thromb Haemost. 2020 07; 18(7):1752-1755.JT

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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Authors+Show Affiliations

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. Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
McIntyre RC
Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
Moore PK
Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
Veress LA
Department of Pediatrics, Pulmonary Medicine, University of Colorado Denver, Aurora, CO, USA.
Yaffe MB
Center for Precision Cancer Medicine, Departments of Biological Engineering and Biology, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Moore HB
Department of Surgery, University of Colorado Denver, Aurora, CO, USA.
Barrett CD
Center for Precision Cancer Medicine, Departments of Biological Engineering and Biology, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

MeSH

AgedBetacoronavirusBlood Coagulation DisordersCOVID-19Coronavirus InfectionsFatal OutcomeFemaleFibrinolysisFibrinolytic AgentsHost-Pathogen InteractionsHumansMaleMiddle AgedPandemicsPneumonia, ViralRecovery of FunctionSARS-CoV-2Thrombolytic TherapyTissue Plasminogen ActivatorTreatment Outcome

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32267998

Clinical Trial Links

BNP, Serum Troponin and D-dimer as Risk Factors in Patients With COVID-19

Citation

Wang, Janice, et al. "Tissue Plasminogen Activator (tPA) Treatment for COVID-19 Associated Acute Respiratory Distress Syndrome (ARDS): a Case Series." Journal of Thrombosis and Haemostasis : JTH, vol. 18, no. 7, 2020, pp. 1752-1755.
Wang J, Hajizadeh N, Moore EE, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost. 2020;18(7):1752-1755.
Wang, J., Hajizadeh, N., Moore, E. E., McIntyre, R. C., Moore, P. K., Veress, L. A., Yaffe, M. B., Moore, H. B., & Barrett, C. D. (2020). Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. Journal of Thrombosis and Haemostasis : JTH, 18(7), 1752-1755. https://doi.org/10.1111/jth.14828
Wang J, et al. Tissue Plasminogen Activator (tPA) Treatment for COVID-19 Associated Acute Respiratory Distress Syndrome (ARDS): a Case Series. J Thromb Haemost. 2020;18(7):1752-1755. PubMed PMID: 32267998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. AU - Wang,Janice, AU - Hajizadeh,Negin, AU - Moore,Ernest E, AU - McIntyre,Robert C, AU - Moore,Peter K, AU - Veress,Livia A, AU - Yaffe,Michael B, AU - Moore,Hunter B, AU - Barrett,Christopher D, Y1 - 2020/05/11/ PY - 2020/04/02/received PY - 2020/04/04/accepted PY - 2020/4/9/pubmed PY - 2020/7/16/medline PY - 2020/4/9/entrez KW - COVID-19 KW - acute respiratory distress syndrome (ARDS) KW - case report KW - fibrinolysis KW - tissue plasminogen activator (tPA) SP - 1752 EP - 1755 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 18 IS - 7 N2 - 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. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32267998/full_citation L2 - https://doi.org/10.1111/jth.14828 DB - PRIME DP - Unbound Medicine ER -