Ultrasound-assisted thrombolysis for a giant right atrial thrombus and pulmonary embolism in a patient with COVID-19

Victoria-Nandayapa, José Roberto; Arroyo-Rodríguez, Cuitláhuac; Franco-Rodríguez, Salvador Leopoldo; Pérez-Méndez, Fausto Miguel; Soto-Gaxiola, Alan Humberto

doi:10.33963/kp.15961

Cited by 2 publications

(1 citation statement)

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“…The patient was treated with rtPA (the report does not specify the name) [ 46 ]. A case of a 51-year-old diabetic male with ARDS, PE, and massive RHT in whom thrombolysis with alteplase was performed was also reported [ 47 ]. Thrombolysis was performed successfully in all the patients mentioned, and neither death nor serious complications were reported.…”

Section: Discussionmentioning

confidence: 99%

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Oliynyk,

Rorat,

Solyarik

et al. 2023

Viruses

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COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (p = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14–2.62), increased D-dimer concentration (p = 0.02, OR = 1.43 95% CI 1.06–1.93), and decreased PaO2/FiO2 ratio (p = 0.001, OR = 0.56 95% CI 0.41–0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO2/FiO2 <144 mmHg predicted a fatal outcome. The risk of death in patients with severe COVID-19 with ARDS and PE increases with higher D-dimer levels, decreased PaO2/FiO2, and delayed thrombolytic treatment. Thrombolysis seems to be treatment of choice in severe COVID-19 with PE and RHT. It should be carried out as soon as possible after the diagnosis is established.

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Section: Discussionmentioning

confidence: 99%

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Oliynyk,

Rorat,

Solyarik

et al. 2023

Viruses

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Risk assessment of cardiovascular complications in patients treated for SARS-CoV-2 in the observation in infectious disease department

Zalewski,

Dudziński,

Czyżewski

2023

Emerg Med Serv

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Aim: Assessment of the risk of pulmonary embolism and myocardial dysfunction based on the measured levels of d-dimer and troponin-T in patients treated in the hospital for COVID-19. Material and methods: The study included a 3-year retrospective analysis of medical records of patients treated at the Independent Public Healthcare Institution. The authors compared the 12 months preceding the epidemic treating this group of patients (without COVID-19) as a control (comparative), and the 24 months of the epidemic in Poland (patients with COVID-19 infection). Results: Statistically significant differences in d-dimer concentrations before and during the pandemic were found (2.150 ± 3.892 vs. 4.990 ± 15.244 vs. 5.032 ± 13.426 μg/ml; P = 0.046). However, there were no statistically significant differences before and during the pandemic in troponin T concentrations (0.027 ± 0.049 vs. 0.032 ± 0.082 vs. 0.034 ± 0.121 ng/mL; P = 0.718). Comparing the periods of the pandemic and the time before the pandemic, the length of the hospitalization period was statistically significantly extended (8 ± 4 vs. 10 ± 7 vs. 12 ± 7 days; P<0.001). Conclusions: Diagnostics consisting in monitoring the level of d-dimer in patients with COVID-19 allows to reduce the risk of complications, including hospital death. Determining the level of d-dimer and troponin-T allows for the implementation of appropriate treatment in patients with COVID-19. Testing the level of d-dimer is important in making clinical decisions against the risk of flordembolism in adult COVID-19 patients.

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Ultrasound-assisted thrombolysis for a giant right atrial thrombus and pulmonary embolism in a patient with COVID-19

Cited by 2 publications

References 0 publications

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Risk assessment of cardiovascular complications in patients treated for SARS-CoV-2 in the observation in infectious disease department

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