In this episode, I’ll discuss whether alteplase can be used to treat COVID-19 patients with thrombotic disseminated intravascular coagulation.
Many patients severely ill with COVID-19 develop a thrombotic disseminated intravascular coagulation. Fibrinolytic therapy has been studied in patients with acute lung injury previously, and several hospitals are currently enrolling patients with severe COVID-19 and DIC in trials using alteplase.
A group of authors has published a 3-patient case series on the use of alteplase in patients with DIC and COVID-19 in the Journal of Thrombosis and Hemostasis.
Each patient experienced a positive improvement in the PaO2/FiO2 ratio however the benefit proved to be only transient.
The regimen used was to give alteplase 25mg intravenously over 2 hours, followed by a 25mg tPA infusion over the subsequent 22 hours.
None of the three patients had a bleeding event. One patient who descended into multiple organ failure with refractory hypotension secondary to arrhythmia and superimposed bacterial infection died. Mortality and outcome data on the other two patients was not explicitly reported although the article reads like the patients were alive at the time it was written.
Details of further trials using alteplase for DIC from COVID-19 are underway according to lay press reports however I cannot find them registered in clinicaltrials.gov at the time of this writing.
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