Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported. Summary This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest–associated massive pulmonary embolism after failure of previous anticoagulation efforts. Conclusion Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes

“…The infected immune cells respond with cytokine production, and autophagy 33 . Interestingly, a higher rate of reported pulmonary embolism and thrombosis in patients with severe COVID19 [34][35][36] may be attributed to platelet activation after direct infection with the virus and secondary autophagy 37,38 .…”

Multi-organ damage by covid-19: congestive (cardio-pulmonary) heart failure, and blood-heart barrier leakage

“…While every effort is being made by the medical experts to treat patients by taking suitable preventive measures employing anticoagulation therapeutics to deal with the coagulation issues. Despite superb benefits with the use of systemic anticoagulation therapies, the data seem to be retrospective in nature thus raising some questions on the possible interplay of other confounders, as well as, long-term benefits and safety of the systemic anticoagulation approach [26][27][28][29][30][31][32][33][34].…”

Drug Repurposing and Polypharmacology to Fight SARS-CoV-2 Through Inhibition of the Main Protease

“…Moreover, reduced levels of antithrombin, a protein involved in the regulation of the coagulation cascade, have been reported in COVID-19 patients ( Arachchillage et al, 2020 ). Interestingly, according to recent findings, treatment with Argatroban, a direct thrombin inhibitor with anticoagulant effects independent from antithrombin, seems to provide significant therapeutic effects in patients ( Arachchillage et al, 2020 ; Sagardia and Daniels, 2020 ), albeit this drug was shown to be unable to inhibit SARS-CoV-2 replication (NIH 8 ). As the pandemic is spreading, the reported coagulation disorders in COVID-19 patients as in previous SARS and MERS patients should be carefully addressed.…”