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Review
. 2022 Jul 30;10(1):38.
doi: 10.1186/s40560-022-00625-4.

Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS

Shahideh Amini  1 , Aysa Rezabakhsh  2 , Javad Hashemi  3 , Fatemeh Saghafi  4 , Hossein Azizi  5 , Antoni Sureda  6   7 , Solomon Habtemariam  8 , Hamid Reza Khayat Kashani  9 , Zahra Hesari  10 , Adeleh Sahebnasagh  11
Affiliations
Review

Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS

Shahideh Amini et al. J Intensive Care. .

Abstract

Background: In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for coronavirus disease (COVID-19), was identified as the new pathogen to lead pneumonia in Wuhan, China, which has spread all over the world and developed into a pandemic. Despite the over 1 year of pandemic, due to the lack of an effective treatment plan, the morbidity and mortality of COVID-19 remains high. Efforts are underway to find the optimal management for this viral disease.

Main body: SARS-CoV-2 could simultaneously affect multiple organs with variable degrees of severity, from mild to critical disease. Overproduction of pro-inflammatory mediators, exacerbated cellular and humoral immune responses, and coagulopathy such as Pulmonary Intravascular Coagulopathy (PIC) contributes to cell injuries. Considering the pathophysiology of the disease and multiple microthrombi developments in COVID-19, thrombolytic medications seem to play a role in the management of the disease. Beyond the anticoagulation, the exact role of thrombolytic medications in the management of patients with COVID-19-associated acute respiratory distress syndrome (ARDS) is not explicit. This review focuses on current progress in underlying mechanisms of COVID-19-associated pulmonary intravascular coagulopathy, the historical use of thrombolytic drugs in the management of ARDS, and pharmacotherapy considerations of thrombolytic therapy, their possible benefits, and pitfalls in COVID-19-associated ARDS.

Conclusions: Inhaled or intravenous administration of thrombolytics appears to be a salvage therapy for severe ARDS associated with COVID-19 by prompt attenuation of lung injury. Considering the pathogenesis of COVID-19-related ARDS and mechanism of action of thrombolytic agents, thrombolytics appear attractive options in stable patients without contraindications.

Keywords: ARDS; COVID-19; Coagulopathy; Pharmacotherapy; Pro-inflammatory; Thrombolytic therapy.

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Conflict of interest statement

All authors declare to have no competing interests.

Figures

Fig. 1
Fig. 1
Micro- and macro-coagulopathy development during ARDS induced by COVID-19. *Created with BioRender.com
Fig. 2
Fig. 2
Mechanism of action of thrombolytic drugs
Fig. 3
Fig. 3
Intravascular thrombin/fibrin formation pathway and related anti-thrombolytic therapy. *Created with BioRender.com
See this image and copyright information in PMC

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