Combination of thrombolytic and immunosuppressive therapy for coronavirus disease 2019: A case report

Papamichalis, Panagiotis; Papadogoulas, Antonios; Katsiafylloudis, Periklis; Skoura, Apostolia-Lemonia; Papamichalis, Michail; Neou, Evangelia; Papadopoulos, Dimitrios; Karagiannis, Spyridon; Zafeiridis, Tilemachos; Babalis, Dimitris; Komnos, Apostolos

doi:10.1016/j.ijid.2020.05.118

Cited by 18 publications

(25 citation statements)

References 12 publications

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“…Our COVID-19 patient developed ACP and had high values of ferritin, C-reactive protein, hypercapnia, and alveolar dead space; all of these parameters were reduced after rtPA treatment. In the line with our findings, Papamichalis et al reported reduced levels of ferritin and C-reactive protein following the administration of rtPA and tocilizumab ( Papamichalis et al, 2020 ). Hypercapnia has also been linked with the development of ACP and is thought to represent one of the factors responsible for vasoconstriction and the augmentation of pulmonary arterial pressure ( Jardin and Vieillard-Baron, 2009 , Biswas, 2016 , Boissier et al, 2013 ).…”

Section: Discussionsupporting

confidence: 93%

Recombinant tissue plasminogen activator treatment for COVID-19 associated ARDS and acute cor pulmonale

Kosanovic

Yaroshetskiy

Tsareva

et al. 2021

International Journal of Infectious Diseases

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Existing literature highlights the fact that patients with COVID-19 exhibit alterations in the coagulation process and are associated with respiratory and cardiovascular diseases, including acute respiratory distress syndrome and acute cor pulmonale. In this report, we describe the effects of systemic thrombolysis on acute cor pulmonale in a patient suffering from COVID-19. We demonstrated that systemic thrombolysis successfully improved the hemodynamics of our patient and resulted in a prominent reduction in hypercapnia, alveolar dead space, and ventilatory ratio.

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Section: Discussionsupporting

confidence: 93%

Recombinant tissue plasminogen activator treatment for COVID-19 associated ARDS and acute cor pulmonale

Kosanovic

Yaroshetskiy

Tsareva

et al. 2021

International Journal of Infectious Diseases

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“…This is likely attributable to presenting location/etiology of ischemia and the degree to which symptoms developed. The most common medical 8 while in two other cases tocilizumab was used in addition to antibiotics and antivirals with and without anticoagulation respectively. 5 Other immunotherapy medications such as glucocorticoids and IgG were described as well with some success.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 and limb ischemia: A systematic review

Putko

Bedrin

Clark

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Recent spread of severe acute respiratory coronavirus syndrome-2 (SARS-CoV-2) has led to the coronavirus disease (COVID-19) pandemic, resulting in new challenges across all medical specialties. Limb and digit ischemia have been associated with COVID-19 infection. This systematic review includes primary studies of COVID-19 limb ischemia to identify risk factors, comorbidities, case characteristics, and treatment strategies to better understand the nature of this disease and its effects on the extremities. Methods: A literature search for studies detailing COVID-19 infected patients with limb or digit ischemia was performed, identifying 157 articles, 12 of which met inclusion criteria, accounting for 47 patients. Inclusion criteria were (1) primary studies, (2) positive disease diagnosis (3) limb ischemia, (4) reported treatment. Demographic data, case characteristics, treatments, outcomes and mortality were collected and pooled. Results: The average patient age was 67.6 years, predominantly male (79.6%). Of the 44 cases discussing treatment, 13 (30%) patients underwent medical treatment alone, while 23 (52.3%) patients underwent medical plus surgical treatment. Four patients (9.1%) were treated with observation. In 10 of the 12 studies, lab findings, thrombosis, or conclusions supporting a hypercoagulable state as a cause of limb/ digit ischemia were cited. Five patients (10.6%) were on vasopressors and 8 patients (17.0%) were on a ventilator. Of those treated with observation alone, there was 100% resolution of symptoms. Of those treated medically without surgical intervention (17 patients), 6 patients (35.3%) were reported to have revascularization, 6 patients (35.3%) died, and the remaining outcomes were not reported. Medical and surgical treatment resulted in one limb amputation (4.4%) and altogether 74% of patients achieved revascularization of the affected limb/digit. Mortality rate was 45%. Conclusions: COVID-19 infection may be associated with increased risk of limb or digital ischemia, although the quality of evidence supporting this theory is limited. Evidence of inflammatory-mediated thrombosis and endothelial injury are possible explanations which would support the use of immunotherapy in addition to anticoagulation for treatment or prevention of thromboembolic events. Current outcomes and treatment strategies are variable. Level of evidence: IV.

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“…Tissue plasminogen activators (TPA), antihemophilic factors, immune globulin, and anti-thymocyte globulin are found to be good candidates in COVID-19 treatment as per our various omics-based analyses. Reports suggest that, TPA with targeted anti-inflammatory treatment may be a potential therapy against COVID-19 [ 38 ]. Tenecteplase, a TPA, that is identified in our analysis, is considered in managing acute coronary syndromes associated with COVID-19 [ 39 ] and is currently under clinical trial to manage COVID-19 patients (NCT04505592).…”

Section: Discussionmentioning

confidence: 99%

Multi-omics-based identification of SARS-CoV-2 infection biology and candidate drugs against COVID-19

Barh

Tiwari

Weener³

et al. 2020

Computers in Biology and Medicine

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SARS-CoV-2 has ushered a global pandemic with no effective drug being available at present. Although several FDA-approved drugs are currently under clinical trials for drug repositioning, there is an on-going global effort for new drug identification. In this paper, using multi-omics (interactome, proteome, transcriptome, and bibliome) data and subsequent integrated analysis, we present the biological events associated with SARS-CoV-2 infection and identify several candidate drugs against this viral disease. We found that: (i) Interactome-based infection pathways differ from the other three omics-based profiles. (ii) Viral process, mRNA splicing, cytokine and interferon signaling, and ubiquitin mediated proteolysis are important pathways in SARS-CoV-2 infection. (iii) SARS-CoV-2 infection also shares pathways with Influenza A, Epstein-Barr virus, HTLV-I, Measles, and Hepatitis virus. (iv) Further, bacterial, parasitic, and protozoan infection pathways such as Tuberculosis, Malaria, and Leishmaniasis are also shared by this virus. (v) A total of 50 candidate drugs, including the prophylaxis agents and pathway specific inhibitors are identified against COVID-19. (vi) Betamethasone, Estrogen, Simvastatin, Hydrocortisone, Tositumomab, Cyclosporin A etc. are among the important drugs. (vii) Ozone, Nitric oxide, plasma components, and photosensitizer drugs are also identified as possible therapeutic candidates. (viii) Curcumin, Retinoic acids, Vitamin D, Arsenic, Copper, and Zinc may be the candidate prophylaxis agents. Nearly 70% of our identified agents are previously suggested to have anti-COVID-19 effects or under clinical trials. Among our identified drugs, the ones that are not yet tested, need validation with caution while an appropriate drug combination from these candidate drugs along with a SARS-CoV-2 specific antiviral agent is needed for effective COVID-19 management.

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Combination of thrombolytic and immunosuppressive therapy for coronavirus disease 2019: A case report

Cited by 18 publications

References 12 publications

Recombinant tissue plasminogen activator treatment for COVID-19 associated ARDS and acute cor pulmonale

Recombinant tissue plasminogen activator treatment for COVID-19 associated ARDS and acute cor pulmonale

SARS-CoV-2 and limb ischemia: A systematic review

Multi-omics-based identification of SARS-CoV-2 infection biology and candidate drugs against COVID-19

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