Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

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

doi:10.3390/v15071513

Impact of Alteplase on Mortality in Critically Ill Patients with COVID-19 and Pulmonary Embolism

Viruses. 2023 Jul 7;15(7):1513. doi: 10.3390/v15071513.

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, Ukraine.
² Department of Emergency Medicine, Rzeszow University, 35-310 Rzeszow, Poland.
³ Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland.
⁴ Department of Anesthesiology and Intensive Care, Kyiv City Clinical Hospital No 4, 01030 Kyiv, Ukraine.
⁵ Department of Medical Statistics, Bogomolets National Medical University, 01601 Kyiv, Ukraine.
⁶ Department of Civilization Diseases, University of Information Technology and Management in Rzeszow, 35-310 Rzeszow, Poland.
⁷ Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland.
⁸ Department of Human Physiology, Rzeszow University, 35-310 Rzeszow, Poland.

Abstract

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 (p = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14-2.62), increased D-dimer concentration (p = 0.02, OR = 1.43 95% CI 1.06-1.93), and decreased PaO₂/FiO₂ ratio (p = 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 PaO₂/FiO₂ <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 PaO₂/FiO₂, 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.

Keywords: SARS-CoV-2; anticoagulants; respiratory failure; thrombosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
Critical Illness
Heparin / adverse effects
Humans
Pulmonary Embolism* / drug therapy
Respiratory Distress Syndrome* / drug therapy
Retrospective Studies
Thrombosis* / chemically induced
Tissue Plasminogen Activator / therapeutic use

Substances

Heparin
Tissue Plasminogen Activator

Grants and funding

The study was a part of the clinical research “Optimisation of respiratory support methods for patients with severe forms of respiratory insufficiency, including acute respiratory distress syndrome”, conducted in the Department of Anaesthesiology and Intensive Care, Bohomolets National Medical University, Kyiv, Ukraine, and registered in the Clinical Trials Register of the State Expert Centre of the Ministry of Health of Ukraine (registration number 0112U001413). This work was also carried out according to the subject register in Simple system SUBZ.A120.23.071 and supported by a statutory subsidy granted by the Ministry of Science and Higher Education in Poland.