Successful use of tPA for thrombolysis in COVID related ARDS: a case series

Abstract

We describe successful usage of low dose Tissue plasminogen activator (tPA) (30-50 mg) in three COVID19 critically ill patients, who were in worsening respiratory failure in-spite of being on therapeutic anticoagulation. All patients had respiratory rate > 40; FiO 2 > 0.7(on NIV); PiO 2 /FiO 2 ratio < 100 and D-dimer>1000 ng/ml. C.T. Pulmonary Angiography could not be done in these patients due to poor general condition, but 2D echo was normal 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. All patients became off oxygen within 3-7 days and were discharged within 2 weeks. The whole idea was to prevent intubation, since mortality rates are very high in intubated COVID19 patients. tPA is associated with <1% risk of fatal bleed. In this unprecedented pandemic with high mortality rates, thrombolysis could be an effective and safe option in carefully selected critically ill patients of COVID19. Keywords Thrombolysis • COVID19 • Acute respiratory distress syndrome (ARDS) • Coagulopathy • Tissue plasminogen activator (tPA) Highlights• COVID19 related coagulopathy can cause extensive pulmonary micro thrombosis leading to ARDS and is one of the most important reasons for mortality. • We report three cases of COVID-19 disease who were in severe ARDS (PiO 2 /FiO 2 ratio < 100) and were on the verge of intubation. • Although no evidence of PTE was present on 2D echo, thrombolysis was done with low dose tPA; all patients had significant improvement and became off oxygen within 3-7 days.• Thrombolysis could be an effective and safe option in carefully selected critically ill patients of COVID19 ARDS and can prevent mortality.

“Locked up inside home” – Head injury patterns during coronavirus disease of 2019 pandemic

“…The significant decline in number of chronic SDH during the COVID-19 pandemic indicates that many patients avoided coming to the hospitals for these conditions, as most patients of chronic SDH are elderly and may not present with any acute symptoms. As COVID-19 is known to affect elderly population badly,[ 12 , 18 ] the attendants of these patients of chronic SDH might have preferred to keep them home for the fear of contracting COVID-19. In certain cases, difficulty in transporting head injury victims during lockdown in our hilly state might also have been responsible for under-reporting of mild and moderate head injured patients.…”

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

“…95 All three patients were experiencing ARDS related respiratory failure, and had improvements in their ventilatory parameters and oxygenation following t-PA therapy, however the effects were transient. A second case series of three patients with significantly worsening ventilatory parameters and oxygenation were administered t-PA. One patient received 30 mg over 15 hours (2 mg/hr), while the over two received 50 mg over 3 hours 96 . All patients experienced improvement in ventilatory parameters and oxygenation and were discharged alive.…”

“…A second case series of three patients with significantly worsening ventilatory parameters and oxygenation were administered t‐PA. One patient received 30 mg over 15 hours (2 mg/hr), while the over two received 50 mg over 3 hours 96 . All patients experienced improvement in ventilatory parameters and oxygenation and were discharged alive 97 .…”

Severe Acute Thromboinflammation: Case Report of Individualized Homeopathic Treatment

“…Recently, tissue plasminogen activator was successfully tested in a small series of COVID-19 critical patients with SARS. 15,16 Blood thinners, in turn, are indicated to prevent the occurrence or to limit the extension and complications of already existing clots. 12 The single medication used by the patient reported here was Apis 30x, 1 teaspoonful every 2 hours, with no detectable manifestation of the so-called homeopathic aggravation or any other side effect, as reported by the patient.…”