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10.1016/j.ajem.2020.07.068

http://scihub22266oqcxt.onion/10.1016/j.ajem.2020.07.068
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32763101!7392155!32763101
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suck abstract from ncbi


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pmid32763101      Am+J+Emerg+Med 2021 ; 41 (ä): 261.e1-261.e3
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  • Thrombolysis in severe COVID-19 pneumonia with massive pulmonary embolism #MMPMID32763101
  • Alharthy A; Faqihi F; Papanikolaou J; Balhamar A; Blaivas M; Memish ZA; Karakitsos D
  • Am J Emerg Med 2021[Mar]; 41 (ä): 261.e1-261.e3 PMID32763101show ga
  • OBJECTIVE: No guidelines exist for the management of massive pulmonary embolism (PE) in COVID-19. We present a COVID-19 patient with refractory acute respiratory syndrome (ARDS), and life-threatening PE who underwent successful thrombolysis. CASE PRESENTATION: A previously healthy 47 year old male was admitted to our hospital due to severe COVID-19 pneumonia [confirmed by Real-Time-Polymerase-Chain-Reaction (RT-PCR)]. He had rapidly evolving ARDS [partial arterial pressure of oxygen to fractional inspired concentration of oxygen ratio: 175], and sepsis. Laboratory results showed lymphocytopenia, and increased D-dimer levels (7.7 mug/ml; normal: 0-0.5 mug/ml). The patient was treated in the intensive care unit. On day-1, ARDS-net/prone positioning ventilation, and empiric anti-COVID treatment integrating prophylactic anticoagulation was administered. On hospital day-2, the patient developed shock with worsening oxygenation. Point-of-care-ultrasound depicted a large thrombus migrating from the right atrium to the pulmonary circulation. Intravenous alteplase (100 mg over 2 h) was administered as rescue therapy. The patient made an uneventful recovery, and was discharged to home isolation (day-20) on oral rivaroxaban. CONCLUSION: Thrombolysis may have a critical therapeutic role for massive PE in COVID-19; however the risk of potential bleeding should not be underestimated. Point-of-care ultrasound has a pivotal role in the management of refractory ARDS in COVID-19.
  • |*Thrombolytic Therapy[MESH]
  • |COVID-19/*complications[MESH]
  • |Critical Care[MESH]
  • |Fibrinolytic Agents/adverse effects/*therapeutic use[MESH]
  • |Hemorrhage/chemically induced/prevention & control[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Point-of-Care Testing[MESH]
  • |Pulmonary Embolism/diagnostic imaging/*drug therapy/*etiology[MESH]
  • |SARS-CoV-2[MESH]
  • |Tissue Plasminogen Activator/adverse effects/*therapeutic use[MESH]


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