Details

Autor(en) / Beteiligte

• Alharthy, Abdulrahman
• Faqihi, Fahad
• Papanikolaou, John
• Balhamar, Abdullah
• Blaivas, Mike
• Memish, Ziad A.
• Karakitsos, Dimitrios

Titel

Thrombolysis in severe COVID-19 pneumonia with massive pulmonary embolism

Ist Teil von

• The American journal of emergency medicine, 2021-03, Vol.41, p.261.e1-261.e3

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• No guidelines exist for the management of massive pulmonary embolism (PE) in COVID-19. We present a COVID-19 patient with refractory acute respiratory syndrome (ARDS), and life-threatening PE who underwent successful thrombolysis. A previously healthy 47 year old male was admitted to our hospital due to severe COVID-19 pneumonia [confirmed by Real-Time-Polymerase-Chain-Reaction (RT-PCR)]. He had rapidly evolving ARDS [partial arterial pressure of oxygen to fractional inspired concentration of oxygen ratio: 175], and sepsis. Laboratory results showed lymphocytopenia, and increased D-dimer levels (7.7 μg/ml; normal: 0–0.5 μg/ml). The patient was treated in the intensive care unit. On day-1, ARDS-net/prone positioning ventilation, and empiric anti-COVID treatment integrating prophylactic anticoagulation was administered. On hospital day-2, the patient developed shock with worsening oxygenation. Point-of-care-ultrasound depicted a large thrombus migrating from the right atrium to the pulmonary circulation. Intravenous alteplase (100 mg over 2 h) was administered as rescue therapy. The patient made an uneventful recovery, and was discharged to home isolation (day-20) on oral rivaroxaban. Thrombolysis may have a critical therapeutic role for massive PE in COVID-19; however the risk of potential bleeding should not be underestimated. Point-of-care ultrasound has a pivotal role in the management of refractory ARDS in COVID-19. •An increased incidence of thromboembolism was reported in critically ill COVID-19 patients.•Enhanced anticoagulation in critically ill COVID-19 patients with D-dimer>3.0 μg/ml remains controversial.•No clear guidelines exist for the management of massive pulmonary embolism in COVID-19.•Thrombolysis has a critical role in the management of life-threatening pulmonary embolism in COVID-19 patients.•COVID-19 patients undergoing thrombolysis should be carefully monitored for the risk of potential bleeding.•Point-of-care ultrasound has a pivotal role in the management of refractory acute respiratory syndrome in COVID-19.