Efficacy and Safety of Thrombolysis in COVID-19 Related ARDS

Abstract

Introduction: COVID19 causes significant pulmonary microthrombi in some individuals, which can lead to ARDS and death. Thrombolysis could be an effective approach in some patients with severe ARDS. We describe our experience with usage of thrombolytic agents in COVID19 critically ill patients, who were in worsening respiratory failure. Methodology: 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 saw dramatic changes in oxygenation (defined by decrease in FiO2 by ≥0.2) in twenty patients. Five patients had major bleed. Eleven patients survived (survival rate of 40.7%) and 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.

Prescription patterns in an intensive care unit of COVID‐19 patients in Bangladesh: A cross‐sectional study

“…37 Several individuals are significantly inclined to develop tiny blood emboli in their lungs as a consequence of COVID-19, which can cause acute respiratory distress syndrome, a symptom of severe COVID-19 diseases, and lead to death. 38 Anticoagulants such as enoxaparin, unfractionated heparin, and rivaroxaban are often given to COVID-19 patients as part of their treatment. 39 In this study, the same pattern may apply to heal such embolism of severe COVID-19 patients, anticoagulants were used in more than two-thirds of the patients (71.73%) (Table 3).…”

“…Several individuals are significantly inclined to develop tiny blood emboli in their lungs as a consequence of COVID‐19, which can cause acute respiratory distress syndrome, a symptom of severe COVID‐19 diseases, and lead to death 38 . Anticoagulants such as enoxaparin, unfractionated heparin, and rivaroxaban are often given to COVID‐19 patients as part of their treatment 39 .…”