Table 1 Summary of clinical studies prescribing thrombolytic agents in COVID-19-associated ARDS
From: Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS
Thrombolytic agents | No. of patients | Study design | Dosage/duration | Main outcomes | References |
|---|---|---|---|---|---|
t-PA | 3 | Case series | 25Â mg intravenously (first 2Â h) and 25Â mg (subsequent 22Â h) | Transient improvement in their respiratory status | [108] |
Low dose t-PA | 3 | Case series | 30–50 mg | Significant increase oxygenation, off oxygen within 3–7 days | [119] |
Plasminogen | 13 | Clinical trial | 10Â mg/ twice daily | Increased oxygenation, relief of chest tightness | [117] |
t-PA | 10,000 | Simulation study (Markov model) | – | Reduced mortality (47.6% [t-PA] versus 71.0% [no t-PA]) | [120] |
Recombinant t-PA, LMWH Enoxaparin, and tocilizumab (anti-IL-6 receptor) | 1 | A case report | 25Â mg intravenously (first 2Â h) and 25Â mg (subsequent 22Â h) | resolution of the skin ischemia and cytokine release syndrome (CRS), improved respiratory parameters, no adverse effects | [118] |
t-PA | 5 | Case series | 25 mg (first 2 h) + 25 mg (subsequent 22 h) and 50 mg (first 5 h) + 50 mg (subsequent 24 h) | All 5 patients to had an improved respiratory status following t-PA administration | [109] |
t-PA | 46 | Clinical trial | 25Â mg over 2Â h then 25Â mg for the next 22Â h of drug infusion, immediately followed by UFH | no significant difference between groups in terms of PaO2/FiO2 ratio or SOFA score, as well as no risk of major bleeding or thrombotic events | [112] |
t-PA | 59 | Cohort | 50Â mg initial bolus, with the median cumulative dose of 50Â mg for the median infusion time of 2Â h | No beneficial effects in improving oxygenation or hemodynamic parameters | [113] |
t-PA | 1 | Case report | 25 mg (first 2 h) and 25 mg (subsequent 22 h) | The patient’s hemodynamics improved, as well as his hypercapnia, alveolar dead space, and ventilatory ratio | [121] |