Abstract
Coronavirus disease 2019 (COVID-19) is associated with abnormal hemostasis, autopsy evidence of systemic microthrombosis, and a high prevalence of venous thromboembolic disease. Tissue plasminogen activator (tPA) has been used in patients with critically ill COVID-19 with high clinical suspicion of pulmonary embolism (PE). A retrospective cohort study of 6095 hospitalized COVID-19 patients at 5 acute care hospitals in New York was conducted. 57 patients received tPA for presumed PE during March 10th to April 27th. The mean age was 60.8 ± 10.8 years, and 71.9% (41/57) were male. We defined strongly suspected PE among 75.4% (43/57) of patients who had acute worsening of hypoxia and acute hypotension requiring pressors. The findings suggestive of PE included right ventricular (RV) strain in 15.8% (9/57), deep venous thrombosis (DVT) in 7.0% (4/57), increased dead space ventilation (Vd) in 31.6% (18/57) of patients, respectively. RV strain and RV thrombus were present in 3.5% (2/57), RV strain and DVT in 5.3% (3/57), RV strain and increased Vd in 8.8% (5/57), and DVT and increased Vd in 3.5% (2/57) of patients. Chest CT Angiography was not performed in any of the patients. Following tPA infusion, 49.1% (28/57) of patients demonstrated improvement. Six patients (10.5%) survived to discharge, of whom 2 received extracorporeal membrane oxygenation and were transferred to other facilities for lung transplant, 2 were discharged home, and 2 were discharged to a rehabilitation facility. However, overall mortality was 89.5%. The utility of tPA for critically ill patients with COVID-19 and presumed PE warrants further studies.
Keywords: COVID-19; Pulmonary embolism; Respiratory insufficiency; Shock; Tissue plasminogen activator.
【저자키워드】 COVID-19, Shock, Pulmonary embolism, respiratory insufficiency, tissue plasminogen activator, 【초록키워드】 Coronavirus disease 2019, hypoxia, hospital, Ventilation, pulmonary, Autopsy, discharge, Hemostasis, Prevalence, extracorporeal membrane oxygenation, Critically ill, male, Patient, age, Thrombus, Deep venous thrombosis, respiratory, utility, New York, disease, Care, patients, lung transplant, hospitalized COVID-19 patient, Evidence, DVT, angiography, Critically ill patient, retrospective cohort study, overall mortality, clinical suspicion, worsening, rehabilitation facility, dead, venous thromboembolic, discharged home, defined, performed, conducted, demonstrated, discharged, survived, transferred, ventricular, with COVID-19, 【제목키워드】 outcome, Characteristics, Ill, patients with COVID-19,