Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism
COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 202...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/15/7/1513 |
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| author | Oleksandr Valentynovych Oliynyk Marta Rorat Serhij Oleksandrovych Solyarik Vitaliy Andrijovych Lukianchuk Serhij Oleksandrovych Dubrov Vitaliy Hrygorovych Guryanov Yanina Volodymyrivna Oliynyk Svitlana Mykolaivna Yaroslavskaya Roman Szalast Wojciech Barg |
| author_facet | Oleksandr Valentynovych Oliynyk Marta Rorat Serhij Oleksandrovych Solyarik Vitaliy Andrijovych Lukianchuk Serhij Oleksandrovych Dubrov Vitaliy Hrygorovych Guryanov Yanina Volodymyrivna Oliynyk Svitlana Mykolaivna Yaroslavskaya Roman Szalast Wojciech Barg |
| author_sort | Oleksandr Valentynovych Oliynyk |
| collection | DOAJ |
| description | COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (<i>p</i> = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14–2.62), increased D-dimer concentration (<i>p</i> = 0.02, OR = 1.43 95% CI 1.06–1.93), and decreased PaO<sub>2</sub>/FiO<sub>2</sub> ratio (<i>p</i> = 0.001, OR = 0.56 95% CI 0.41–0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO<sub>2</sub>/FiO<sub>2</sub> <144 mmHg predicted a fatal outcome. The risk of death in patients with severe COVID-19 with ARDS and PE increases with higher D-dimer levels, decreased PaO<sub>2</sub>/FiO<sub>2</sub>, and delayed thrombolytic treatment. Thrombolysis seems to be treatment of choice in severe COVID-19 with PE and RHT. It should be carried out as soon as possible after the diagnosis is established. |
| first_indexed | 2024-03-11T00:34:13Z |
| format | Article |
| id | doaj.art-6b92493f8bb045b1be4cee6c1a3d761d |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-11T00:34:13Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-6b92493f8bb045b1be4cee6c1a3d761d2023-11-18T21:44:45ZengMDPI AGViruses1999-49152023-07-01157151310.3390/v15071513Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary EmbolismOleksandr Valentynovych Oliynyk0Marta Rorat1Serhij Oleksandrovych Solyarik2Vitaliy Andrijovych Lukianchuk3Serhij Oleksandrovych Dubrov4Vitaliy Hrygorovych Guryanov5Yanina Volodymyrivna Oliynyk6Svitlana Mykolaivna Yaroslavskaya7Roman Szalast8Wojciech Barg9Department of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, UkraineDepartment of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, PolandDepartment of Anesthesiology and Intensive Care, Kyiv City Clinical Hospital No 4, 01030 Kyiv, UkraineDepartment of Anesthesiology and Intensive Care, Kyiv City Clinical Hospital No 4, 01030 Kyiv, UkraineDepartment of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, UkraineDepartment of Medical Statistics, Bogomolets National Medical University, 01601 Kyiv, UkraineDepartment of Civilization Diseases, University of Information Technology and Management in Rzeszow, 35-310 Rzeszow, PolandDepartment of Anesthesiology and Intensive Care, Kyiv City Clinical Hospital No 4, 01030 Kyiv, UkraineDepartment of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, PolandDepartment of Human Physiology, Rzeszow University, 35-310 Rzeszow, PolandCOVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (<i>p</i> = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14–2.62), increased D-dimer concentration (<i>p</i> = 0.02, OR = 1.43 95% CI 1.06–1.93), and decreased PaO<sub>2</sub>/FiO<sub>2</sub> ratio (<i>p</i> = 0.001, OR = 0.56 95% CI 0.41–0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO<sub>2</sub>/FiO<sub>2</sub> <144 mmHg predicted a fatal outcome. The risk of death in patients with severe COVID-19 with ARDS and PE increases with higher D-dimer levels, decreased PaO<sub>2</sub>/FiO<sub>2</sub>, and delayed thrombolytic treatment. Thrombolysis seems to be treatment of choice in severe COVID-19 with PE and RHT. It should be carried out as soon as possible after the diagnosis is established.https://www.mdpi.com/1999-4915/15/7/1513SARS-CoV-2anticoagulantsthrombosisrespiratory failure |
| spellingShingle | Oleksandr Valentynovych Oliynyk Marta Rorat Serhij Oleksandrovych Solyarik Vitaliy Andrijovych Lukianchuk Serhij Oleksandrovych Dubrov Vitaliy Hrygorovych Guryanov Yanina Volodymyrivna Oliynyk Svitlana Mykolaivna Yaroslavskaya Roman Szalast Wojciech Barg Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism Viruses SARS-CoV-2 anticoagulants thrombosis respiratory failure |
| title | Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism |
| title_full | Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism |
| title_fullStr | Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism |
| title_full_unstemmed | Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism |
| title_short | Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism |
| title_sort | impact of alteplase on mortality in critically ill patients with covid 19 and pulmonary embolism |
| topic | SARS-CoV-2 anticoagulants thrombosis respiratory failure |
| url | https://www.mdpi.com/1999-4915/15/7/1513 |
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