Title:Efficacy and Safety of Thrombolysis in COVID-19 Related ARDS
Volume: 18
Issue: 3
Author(s): Abhishek Goyal*, Yogesh Niwariya, Neeraj Pawar, Alkesh Khurana and Poonam Chaudhary
Affiliation:
- Department of Pulmonary Medicine, All India Institute of Medical Sciences Bhopal, 5015 Type 5
Quarters AIIMS Campus, Bhopal, India
Keywords:
Thrombolysis, COVID-19, acute respiratory distress syndrome (ARDS), coagulopathy, tissue plasminogen activator (tPA), tenecteplase (TNK), streptokinase.
Abstract:
Introduction: COVID-19 causes significant pulmonary microthrombi in
some individuals, leading to ARDS and death. Thrombolysis could be an effective approach
in some patients with severe ARDS. We describe our experience with the usage
of thrombolytic agents in critically ill COVID-19 patients who were in worsening
respiratory failure.
Methods: Retrospective chart analysis was done in patients who were thrombolysed
between May 2020-Sept 2020. Analysis was done to find out factors associated with
improvement in oxygenation and survival.
Results: Twenty-seven patients with severe ARDS [all had respiratory rate >30, FiO2
>0.6 (on NIV/HFNC) and PiO2/FiO2 ratio <120] were thrombolysed in our ICU for
COVID19 causes. C.T. Pulmonary Angiography could not be done in any of the 27
patients due to poor general condition, but 2D echo was normal in most (5 had dilated
RA, RV), and none of the patients was in shock. So, there was no conventional indication
of thrombolysis in these patients, yet after thrombolysis, we observed dramatic
changes in oxygenation (defined by a decrease in FiO2 by ≥0.2) in twenty patients.
Five patients had a major bleed. Eleven patients survived (survival rate of 40.7%) and
the survival rate was high {66% (8/12)} in patients who were thrombolysed within 2
days of oxygen requirement.
Conclusion: In this unprecedented pandemic with high mortality rates, efficacy of
early thrombolysis needs to be further explored in randomised controlled trials.