Combination of thrombolytic and immunosuppressive therapy for coronavirus disease 2019: A case report

Abstract

In a proportion of patients, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a multisystem syndrome characterized by hyperinflammation, acute respiratory distress syndrome (ARDS), and hypercoagulability. A 68-year-old man with coronavirus disease 2019 (COVID-19) was admitted to the intensive care unit with respiratory failure, cytokine release syndrome (CRS), and skin ischemia - microthrombosis. Specific coagulation and inflammatory markers (D-dimer, ferritin, and C-reactive protein), along with the clinical picture, triggered the trial of recombinant tissue plasminogen activator (rt-PA) and tocilizumab. This was followed by resolution of the skin ischemia and CRS, while respiratory parameters improved. No major complications associated with rt-PA or tocilizumab occurred. The combination of rt-PA with targeted anti-inflammatory treatment could be a new therapeutic option for patients with COVID-19, ARDS, hyperinflammation, and increased blood viscosity.

Keywords: Acute respiratory distress syndrome; Coronavirus disease 2019; D-dimer; Recombinant tissue plasminogen activator; Tocilizumab.

Fig. 1

The patient's left hand (A) before administering recombinant tissue plasminogen activator (rt-PA)/tocilizumab, and (B) after 12 hours of continuous rt-PA infusion and 2 hours of tocilizumab administration, with resolution. The patient's left foot (C) before administering rt-PA/tocilizumab, and (D) after 12 hours of continuous rt-PA infusion and 2 hours of tocilizumab administration, with resolution.