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. 2024 Nov 28;18(1):572.
doi: 10.1186/s13256-024-04924-2.

Nebulized alteplase in coronavirus disease 2019 pneumonia: a case series

Christopher Milacek  1 , Andreea Nicoleta Stefan  1 , Christina Bal  1 , Matthias Geist  1 , Claudia Guttmann  1 , Marco Idzko  1 , Lukasz Antoniewicz  2
Affiliations

Nebulized alteplase in coronavirus disease 2019 pneumonia: a case series

Christopher Milacek et al. J Med Case Rep. .

Abstract

Background: Many patients with severe coronavirus disease 2019 pneumonia exhibit signs of microthrombosis. Previous studies discussed intravenous fibrinolytic agents as potential add-on therapy in these patients. Therefore, we propose the inhalative administration of fibrinolytics as a possible safer alternative.

Case presentation: This case series describes five white male patients, aged 51-78 years, treated with off-label inhalation of alteplase between November and December 2020. All patients suffered from severe severe acute respiratory syndrome coronavirus 2 infection with respiratory failure. Pulmonary embolism was ruled out by pulmonary angiogram in computed tomography scans, and all patients showed signs of coronavirus disease 2019 pneumonia. Four patients improved clinically, while one patient with advanced chronic diseases died due to multiple organ failure. No directly associated adverse effects were observed following inhalation of alteplase.

Conclusion: This case series warrants further attention to investigate inhalative alteplase as an additional treatment in patients with severe coronavirus disease 2019 infection.

Keywords: Alteplase; COVID-19; Nebulized fibrinolytics; Pneumonia; Respiratory distress.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Five patients underwent “off-label” treatment with nebulized alteplase at the department of pulmonology of the university/tertiary hospital of Vienna between 2 November and 15 December 2020. Data were collected in January 2021. This retrospective case series report was approved by our institutional ethics committee (2362/2020). Consent for publication: Written informed consent was obtained from three patients or the next of kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. In two cases, no contact could be established with the patient or next of kin. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Levels of CRP, platelet count, d-dimer, and fibrinogen prior to and following inhalation of alteplase. All patients received inhaled alteplase at day 0. Patient 5 received an additional inhalation on days 6–10
See this image and copyright information in PMC

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