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