Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review
Abstract The coronavirus disease 2019 (COVID‐19) pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three quarters of patients with COVID‐19 admitted to the intensive care unit, and bot...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-05-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12357 |
| _version_ | 1797759674029703168 |
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| author | Christopher D. Barrett Hunter B. Moore Ernest E. Moore Robert C. McIntyre Peter K. Moore John Burke Fei Hua Joshua Apgar Daniel S. Talmor Angela Sauaia Deborah R. Liptzin Livia A. Veress Michael B. Yaffe |
| author_facet | Christopher D. Barrett Hunter B. Moore Ernest E. Moore Robert C. McIntyre Peter K. Moore John Burke Fei Hua Joshua Apgar Daniel S. Talmor Angela Sauaia Deborah R. Liptzin Livia A. Veress Michael B. Yaffe |
| author_sort | Christopher D. Barrett |
| collection | DOAJ |
| description | Abstract The coronavirus disease 2019 (COVID‐19) pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three quarters of patients with COVID‐19 admitted to the intensive care unit, and both the clinical picture and pathologic findings are consistent with microvascular occlusive phenomena being a major contributor to their unique form of respiratory failure. Numerous studies are ongoing focusing on anticytokine therapies, antibiotics, and antiviral agents, but none to date have focused on treating the underlying thrombotic coagulopathy in an effort to improve respiratory failure in COVID‐19. There are animal data and a previous human trial demonstrating a survival advantage with fibrinolytic therapy to treat acute respiratory distress syndrome. Here, we review the extant and emerging literature on the relationship between thrombotic coagulopathy and pulmonary failure in the context of COVID‐19 and present the scientific rationale for consideration of targeting the coagulation and fibrinolytic systems to improve pulmonary function in these patients. |
| first_indexed | 2024-03-12T18:47:48Z |
| format | Article |
| id | doaj.art-98994b40af9b42eea7341872910e2184 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T18:47:48Z |
| publishDate | 2020-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-98994b40af9b42eea7341872910e21842023-08-02T07:29:44ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792020-05-014452453110.1002/rth2.12357Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and reviewChristopher D. Barrett0Hunter B. Moore1Ernest E. Moore2Robert C. McIntyre3Peter K. Moore4John Burke5Fei Hua6Joshua Apgar7Daniel S. Talmor8Angela Sauaia9Deborah R. Liptzin10Livia A. Veress11Michael B. Yaffe12Center for Precision Cancer Medicine Departments of Biological Engineering and Biology Koch Institute for Integrative Cancer Research Massachusetts Institute of Technology Cambridge MA USAColorado School of Public Health and Department of Surgery University of Colorado Denver Denver CO USAColorado School of Public Health and Department of Surgery University of Colorado Denver Denver CO USAColorado School of Public Health and Department of Surgery University of Colorado Denver Denver CO USADepartment of Medicine University of Colorado Denver, School of Medicine Aurora CO USAApplied BioMath, LLC Concord MA USAApplied BioMath, LLC Concord MA USAApplied BioMath, LLC Concord MA USADepartment of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USAColorado School of Public Health and Department of Surgery University of Colorado Denver Denver CO USADepartment of Pediatrics, Pulmonary Medicine University of Colorado Denver Aurora CO USADepartment of Pediatrics, Pulmonary Medicine University of Colorado Denver Aurora CO USACenter for Precision Cancer Medicine Departments of Biological Engineering and Biology Koch Institute for Integrative Cancer Research Massachusetts Institute of Technology Cambridge MA USAAbstract The coronavirus disease 2019 (COVID‐19) pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three quarters of patients with COVID‐19 admitted to the intensive care unit, and both the clinical picture and pathologic findings are consistent with microvascular occlusive phenomena being a major contributor to their unique form of respiratory failure. Numerous studies are ongoing focusing on anticytokine therapies, antibiotics, and antiviral agents, but none to date have focused on treating the underlying thrombotic coagulopathy in an effort to improve respiratory failure in COVID‐19. There are animal data and a previous human trial demonstrating a survival advantage with fibrinolytic therapy to treat acute respiratory distress syndrome. Here, we review the extant and emerging literature on the relationship between thrombotic coagulopathy and pulmonary failure in the context of COVID‐19 and present the scientific rationale for consideration of targeting the coagulation and fibrinolytic systems to improve pulmonary function in these patients.https://doi.org/10.1002/rth2.12357acute respiratory distress syndromeCOVID‐19fibrinolysispulmonary failuretissue plasminogen activator |
| spellingShingle | Christopher D. Barrett Hunter B. Moore Ernest E. Moore Robert C. McIntyre Peter K. Moore John Burke Fei Hua Joshua Apgar Daniel S. Talmor Angela Sauaia Deborah R. Liptzin Livia A. Veress Michael B. Yaffe Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review Research and Practice in Thrombosis and Haemostasis acute respiratory distress syndrome COVID‐19 fibrinolysis pulmonary failure tissue plasminogen activator |
| title | Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review |
| title_full | Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review |
| title_fullStr | Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review |
| title_full_unstemmed | Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review |
| title_short | Fibrinolytic therapy for refractory COVID‐19 acute respiratory distress syndrome: Scientific rationale and review |
| title_sort | fibrinolytic therapy for refractory covid 19 acute respiratory distress syndrome scientific rationale and review |
| topic | acute respiratory distress syndrome COVID‐19 fibrinolysis pulmonary failure tissue plasminogen activator |
| url | https://doi.org/10.1002/rth2.12357 |
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