Pulmonary Thromboembolism in Patients with Severe COVID-19 Treated with Systemic Low Dose Thrombolytic Drug: A Series of Case Reports

17 Pages Posted: 15 Apr 2022

See all articles by I. Gusti Ngurah Mahaalit Aribawa

I. Gusti Ngurah Mahaalit Aribawa

Udayana University - Department of Anesthesiology and Intensive Care

Christopher Ryalino

Udayana University

Adinda Putra Pradhana

Udayana University

Putu Utami Dewi

Udayana University

Cyndiana Sinardja

Udayana University

Kadek Mulyantari

Udayana University

Abstract

Coronavirus disease 2019 (COVID-19) was associated with respiratory failure and death. Hypercoagulability and thromboembolic complications were found in high percentage of patients and pulmonary thromboembolism (PE) is the most common thrombotic complication. Currently, there is no guidelines in using thrombolysis therapy in COVID-19 patients who developed PE. We present five survivors aged 30-75 years old with confirmed COVID-19. All cases have been proven by computed tomography pulmonary angiography (CTPA) for pulmonary thrombosis and treated with low-dose recombinant tissue plasminogen activator (rtPA). Pulmonary thromboembolism should be suspected in all COVID-19 patients with rapid worsening of dyspnea, desaturation, unexplained shock, and increased level of D-dimer dan fibrinogen. In our cases, pulmonary thromboembolism still develops despite anticoagulation therapy been given. After thrombolytic therapy all patient showed improvement in PaO2/FiO2 ratio. D-dimer showed elevation after thrombolytic therapy and decreased in the following days. Fibrinogen levels are decreased following thrombolytic therapy. Current treatment with anticoagulants seems not enough to halt the course of thrombosis and thrombolysis therapy offers promising result once pulmonary thromboembolism is proven. Systemic thrombolysis therapy is a double-edged sword, and clinicians must balance between benefit and risk of bleeding.

Note:
Funding Information: None to declare.

Conflict of Interests: None to declare.

Patient Informed Consent Statement: The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Keywords: alteplase, COVID-19, thrombolytic, Pulmonary embolism

Suggested Citation

Aribawa, I. Gusti Ngurah Mahaalit and Ryalino, Christopher and Pradhana, Adinda Putra and Dewi, Putu Utami and Sinardja, Cyndiana and Mulyantari, Kadek, Pulmonary Thromboembolism in Patients with Severe COVID-19 Treated with Systemic Low Dose Thrombolytic Drug: A Series of Case Reports. Available at SSRN: https://ssrn.com/abstract=4082822 or http://dx.doi.org/10.2139/ssrn.4082822

I. Gusti Ngurah Mahaalit Aribawa (Contact Author)

Udayana University - Department of Anesthesiology and Intensive Care ( email )

Indonesia

Christopher Ryalino

Udayana University ( email )

Adinda Putra Pradhana

Udayana University ( email )

Putu Utami Dewi

Udayana University ( email )

Cyndiana Sinardja

Udayana University ( email )

Kadek Mulyantari

Udayana University ( email )

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