Abstract Number: PB0229
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: Coronavirus disease 2019 (COVID-19) is associated with abnormal hemostasis, autopsy evidence of systemic microthrombosis, and a high prevalence of venous thromboembolic disease (VTE). Tissue plasminogen activator (tPA) has been used in COVID-19 patients with severe hypoxia with high clinical suspicion of pulmonary embolism (PE).
Aims: We aimed to describe the clinical outcomes of critically ill COVID-19 patients who received tPA.
Methods: A retrospective cohort study was conducted on 6,095 hospitalized COVID-19 patients in the Mount Sinai Health System at 5 hospitals in New York. 57 patients with COVID-19, who were admitted from 3/10 to 4/27, 2020 and received tPA for presumed PE were included in the analysis. Baseline demographic and clinical characteristics, indication for tPA, and overall mortality were reported.
Results: Among the 57 patients who received tPA, the mean age was 60.8 ± 10.8 years, and 71.9% (41/57) were male. PE was suspected among 75.4% (43/57) of patients with supporting findings who had rapidly worsening hypoxia or hypotension. Right ventricular (RV) strain was present 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. 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. No chest CT angiography was performed for any patients due to clinical instability from critical illness. Following tPA infusion, 49.1% (28/57) of patients demonstrated improvement in either of PaO2/FiO2 ratio, blood pressure or partial arterial carbon dioxide. Bleeding complication was seen in 1 patient. Six patients (10.5%) survived to hospital discharge. Overall mortality was 89.5% (51/57).
| Table 1. | |
|---|---|
| tPA indications, n (%) | Total number of patients (n=57) |
| Sole RV strain | 9 (21.1%) |
| RV strain and RV thrombus | 2 (3.5%) |
| RV strain and DVT | 3 (5.3%) |
| RV strain and increased Vd | 5 (8.8%) |
| Sole DVT on US | 4 (7.0%) |
| Sole increased Vd | 18 (31.6%) |
| DVT and increased Vd | 2 (3.5%) |
| Hypoxia and shock without clear evidence of PE | 14 (24.6%) |
Tissue plasminogen activator indications for patients with presumptive diagnosis of pulmonary embolism in deteriorating hypoxia and shock.
| Table 2. | |
|---|---|
| Outcomes and complications, n (%) | Total number of patients (n=57) |
| Improvement after tPA infusion | 28 (49.1%) |
| Bleeding complications within 36 hours of tPA infusion | 1 (1.8%) |
| Death | 51 (89.5%) |
Improvement with successful weaning of ventilator settings and vasopressors, outcomes and complications.
Conclusions: The overall mortality of critically ill COVID-19 patients who received tPA for presumed PE was 89.5 %. The utility of tPA for this indicaition warrants further studies.
To cite this abstract in AMA style:
So M, Steiger D, Takahashi M, Egorova N, TK. The Characteristics and Outcomes of Critically Ill Patients with COVID-19 who Received Systemic Thrombolysis for Presumed Pulmonary Embolism: An Observational Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-characteristics-and-outcomes-of-critically-ill-patients-with-covid-19-who-received-systemic-thrombolysis-for-presumed-pulmonary-embolism-an-observational-study/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
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