Authors: Poor HD, Ventetuolo CE, Tolbert T, Chun G, Serrao G
PMID: 32508062 PMCID: PMC7288983 DOI: 10.1002/ctm2.44
Abstract
Patients with severe COVID-19 disease have been characterized as having the acute respiratory distress syndrome (ARDS). Critically ill COVID-19 patients have relatively well-preserved lung mechanics despite severe gas exchange abnormalities, a feature not consistent with classical ARDS but more consistent with pulmonary vascular disease. Many patients with severe COVID-19 also demonstrate markedly abnormal coagulation, with elevated d-dimers and higher rates of venous thromboembolism. We present four cases of patients with severe COVID-19 pneumonia with severe respiratory failure and shock, with evidence of markedly elevated dead-space ventilation who received tPA. All showed post treatment immediate improvements in gas exchange and/or hemodynamics. We suspect that severe COVID-19 pneumonia causes respiratory failure via pulmonary microthrombi and endothelial dysfunction. Treatment for COVID-19 pneumonia may warrant anticoagulation for milder cases and thrombolysis for more severe disease.
Keywords: COVID-19; tPA; thrombolysis; tissue plasminogen activator.
Source: https://pubmed.ncbi.nlm.nih.gov/32508062/
Archive: https://archive.ph/3oMxu
