International Journal of Critical Illness and Injury Science

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 12  |  Issue : 4  |  Page : 197--203

Systemic Thrombolytics as Rescue Therapy for COVID-19 Patients With Acute Respiratory Distress Syndrome: A Retrospective Observational Study


Prathibha Gowda Ashwathappa, Ipe Jacob, Pradeep Rangappa, Karthik Rao 
 Department of Critical Care, Manipal Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Ipe Jacob
Department of Critical Care, Manipal Hospital, Yeshwantpur, Bengaluru, Karnataka
India

Background: Coronavirus disease 2019 (COVID-19) pneumonia with severe acute respiratory distress syndrome (ARDS) is often associated with a progressive respiratory failure that is refractory to maximal ventilatory support and other ARDS strategies. Studies show evidence of a hypercoagulable state in COVID-19 patients, including capillary thrombosis and alveolar fibrin deposits which impede normal gas exchange. In this context, thrombolysis is considered as a salvage therapy to rescue critically hypoxemic patients. Methods: In this retrospective observational study, the efficacy of thrombolysis on outcome of COVID-19 ARDS with respiratory failure was analyzed. Patients with severe ARDS and d-dimer levels of 5 μg/ml or above were initiated on alteplase, as a 25 mg bolus followed by a 25 mg infusion over 22 h. Primary outcome was intensive care unit (ICU) mortality and secondary outcomes were change in PaO2/FiO2 24 h after thrombolysis, avoidance of intubation, ventilator free days (VFD), and ICU and hospital length-of-stay (LOS). Results: Thirteen out of 34 patients with severe COVID ARDS underwent thrombolysis. They had lower ICU mortality than non-thrombolysed patients (23.1% vs. 71.4%, P = 0.006), greater percentage improvement in PaO2/FiO2 (116% vs. 31.5%, P = 0.002), more VFDs (13 days vs. 0 day, P = 0.004), and lesser requirement for intubation (23.1% vs. 76.2%, P = 0.004). ICU and hospital LOS were similar. Conclusion: Thrombolysis can be considered as a rescue therapy for nonintubated COVID-19 ARDS patients with severe hypoxemic respiratory failure, who show evidence of a procoagulant state. Larger studies are needed before inclusion into the regular treatment protocol for COVID-19 patients.


How to cite this article:
Ashwathappa PG, Jacob I, Rangappa P, Rao K. Systemic Thrombolytics as Rescue Therapy for COVID-19 Patients With Acute Respiratory Distress Syndrome: A Retrospective Observational Study.Int J Crit Illn Inj Sci 2022;12:197-203


How to cite this URL:
Ashwathappa PG, Jacob I, Rangappa P, Rao K. Systemic Thrombolytics as Rescue Therapy for COVID-19 Patients With Acute Respiratory Distress Syndrome: A Retrospective Observational Study. Int J Crit Illn Inj Sci [serial online] 2022 [cited 2023 Jan 29 ];12:197-203
Available from: https://www.ijciis.org/article.asp?issn=2229-5151;year=2022;volume=12;issue=4;spage=197;epage=203;aulast=Ashwathappa;type=0