Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review

Barrett, Christopher D.; Moore, Hunter B.; Moore, Ernest E.; McIntyre, Robert C.; Moore, Peter K.; Burke, John S.; Hua, Fei; Apgar, Joshua F.; Talmor, Daniel; Sauaia, Angela; Liptzin, Deborah R.; Veress, Livia A.; Yaffe, Michael B.

doi:10.1002/rth2.12357

Cited by 42 publications

(56 citation statements)

References 83 publications

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“…Prothrombin time is only minimally prolonged. The more common coagulation ndings with COVID-19 are hypercoagulablity evident in uniquely elevated brinogen and D-dimers [8][9].…”

Section: Discussionmentioning

confidence: 99%

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Simone

Chouillard

Sartelli

et al. 2020

Preprint

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BackgroundSince the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients in emergency setting under COVID-19 pandemic in the safety of the patient and health care workers based on available evidences and experienced surgeons’opinion.MethodA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P)through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.ResultsGiven the limitation of the evidence, the current document represents an effort to provide a guide for emergency surgeons to perform safely surgery during this pandemic on the basis of evidence medicine and principles of mass casualty incident management to limit the diffusion of the infection among patients and health care workers. ConclusionsWe recommend screening for COVID-19 infection at emergency department, all surgical patients with clinical and epidemiologic features suspect for COVID-19 disease who are waiting for hospital admission and urgent surgery. The screening provides performing a RT-PCR naso-pharyngeal swab test and a baseline (non-contrast) chest CT or chest X-ray or lungs US, depending on skills and availability.The management of COVID-19 surgical patient is multidiplinary.If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every efforts to protect the operating room staff, in the safety of the patient . We recommend not being present during the intubation and extubation maneuvers (1A).To perform a safe surgical procedure, we recommend:-having a trained staff, wearing the necessary personal protective equipments, and an established protocol for the preoperative, peri-operative and postoperative management of the COVID-19 surgical patient;-being careful in the establishment and management of the artificial pneumoperitoneum, in the control of the hemostasis and of incisions to prevent any loss of biological fluids and contamination of the surgical staff;-using of all available devices to remove smoke and aerosol during the operation and a closed suction system for artificial pneumoperitoneum, especially if there is a risk of conversion to laparotomy.If it is not possible to perform surgery in a safe and protected environment, we recommend do not underestimating the highest risk of contamination and infection for health care workers and dissemination of the virus in the hospital and to consider transferring the patient in a COVID HUB hospital for the appropriate management.The administration of prophylactic anticoagulation with LMWH is recommended as soon as possible in COVID-19 patients to reduce thromboembolic risk related to the virus and sepsis, decreasing the mortality rate. We recommend to carefully administrating antibiotics in COVID-19 surgical patients for the high risk of selecting resistant bacteria, especially in patients admitted in ICU for mechanical ventilation. Early empirical antibiotic treatment should be targeted to results from cultures, with de-escalation of treatment as soon as possible. We recommend against empirical antifungal treatment in all surgical COVID-19 patients but to consider it in critically ill patients.

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“…Prothrombin time is only minimally prolonged. The more common coagulation ndings with COVID-19 are hypercoagulablity evident in uniquely elevated brinogen and D-dimers [8][9].…”

Section: Discussionmentioning

confidence: 99%

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Simone

Chouillard

Sartelli

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The use unfractionated heparin and LMWH are used in acute CSVT (9). The use of tissueplasminogen activator (t-PA) brinolytic therapy were used in decompensated patients with no options for escalation of care (40). The second patient get brinolytic therapy the next day after the diagnosis CSVT.…”

Section: Discussionmentioning

confidence: 99%

Case Reports of Cerebral Sinus Venous Thrombosis in COVID-19 Patients

Sitanggang

Tini

Susilawathi

et al. 2020

Preprint

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Background: The outbreak of Coronavirus disease 2019 (COVID-19) has started in China since December 2019 and expanding worldwide rapidly with cases of respiratory tract infection and multiple system involvement. Neurological manifestations are not exempted following the reports from various sources about Ischemic and haemorrhagic stroke related to COVID-19, but the reports about cerebral sinus venous thrombosis (CSVT) are still rare.Case presentation: We would like to report two cases of cerebral sinus venous thrombosis in COVID-19 patients following the respiratory manifestations with profound haematological and coagulation disarrangement triggered by COVID-19 and these are assumed as underlying mechanism. These two cases also have different course of disease and outcome which are interesting.Conclusions: CSVT is one of neurological complication and COVID -19 manifestation that can have grave prognosis, if this involves the brainstem venous drainage. Thrombogenesis and coagulation cascades are prolonged despite successful alteration to negative result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) reverse transcription polymerase chain reaction (rt-PCR) test. Therefore, monitoring neutrophil to lymphocyte ration (NLR), D-dimer level, fibrinogen and C-reactive protein (CRP) is paramount as well as indicators of poor prognosis.

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“…Nonetheless, the scientific rationale for using fibrinolytic therapy in COVID-19 ARDS-namely, the consistent findings of pulmonary microvascular thrombosis-has resulted in the initiation of urgently needed clinical trials studying the role of antithrombotic agents in COVID-19 ARDS. 66…”

Section: Anticoagulation and Thrombolyticsmentioning

confidence: 99%

Acute Respiratory Distress Syndrome

et al. 2020

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A cute respiratory distress syndrome (ARDS) is defined as hypoxemia secondary to a rapid onset of noncardiogenic pulmonary edema. 1 Etiologic risk factors for ARDS encompass both direct and indirect lung injuries including but not limited to pneumonia, sepsis, noncardiogenic shock, aspiration, trauma, contusion, transfusion, and inhalation injuries. Although clinical recognition and management of ARDS have improved significantly over the past 25 yr, it is still a leading cause of death in critically ill patients, with mortality rates consistently reported around 30 to 40%. 2 An important factor in the high mortality rate in ARDS is that treatment is mainly focused on clinical management and no targeted therapies currently exist. Furthermore, ARDS management is often challenging as it commonly occurs in a clinical setting of multiple organ failure and can also lead to the development of nonpulmonary organ injury, such as acute kidney injury. 3 Recently, the pandemic caused by coronavirus disease 2019 (COVID-19), which results from infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has led to a dramatic incidence in COVID-19-related ARDS. Thirty to forty percent of COVID-19 hospitalized patients develop ARDS, and it is associated with 70% of fatal cases. 4,5 At the time of this writing (July 31, 2020), there are more than 4.5 million COVID-19 cases and 152,000 related deaths in the United States. 6 Here, we describe select management strategies that have become foundations of ARDS clinical management and provide an update of emerging approaches for the treatment of ARDS related to COVID-19.

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Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review

Cited by 42 publications

References 83 publications

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

The management of surgical patients in emergency setting during COVID-19 pandemic. The WSES position paper

Case Reports of Cerebral Sinus Venous Thrombosis in COVID-19 Patients

Acute Respiratory Distress Syndrome

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