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Fibrinolytic Therapy for Refractory COVID‐19 Acute Respiratory Distress Syndrome: Scientific Rationale and Review
Author(s):
Christopher D. Barrett
,
Christopher D. Barrett
Affiliations:
Hunter B. Moore
,
Hunter B. Moore
Affiliations:
,
Ernest E. Moore
Affiliations:
Colorado School of Public Health and Department of Surgery, University of Colorado Denver, Denver, CO, USA Ernest E Moore Shock Trauma Center at Denver Health, Department of Surgery, Denver, CO, USA
Robert C. McIntyre
,
Robert C. McIntyre
Affiliations:
Peter K Moore
,
Peter K Moore
Affiliations:
John Burke
,
John Burke
Affiliations:
Fei Hua
,
Fei Hua
Affiliations:
Joshua Apgar
,
Joshua Apgar
Affiliations:
Daniel S. Talmor
,
Daniel S. Talmor
Affiliations:
Angela Sauaia
,
Angela Sauaia
Affiliations:
Deborah R. Liptzin
,
Deborah R. Liptzin
Affiliations:
Livia A. Veress
,
Livia A. Veress
Affiliations:
Michael B. Yaffe
Affiliations:
Koch Institute for Integrative Cancer Research, Center for Precision Cancer Medicine, Departments of Biological Engineering and Biology, Massachusetts Institute of Technology, Cambridge, MA, USA Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
ISTH Academy. Yaffe M. 04/28/20; 297670
Michael Yaffe
Michael Yaffe
Contributions
Journal Abstract
Abstract
The 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 COVID‐19 patients 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 anti‐cytokine therapies, antibiotics and anti‐viral agents, but none to‐date have focused on treating the underlying thrombotic coagulopathy in an effort to improve respiratory failure in COVID‐19. There is animal data and a previous human trial demonstrating a survival advantage with fibrinolytic therapy to treat ARDS. 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.

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