key: cord-0849607-46ohny64
authors: Qanadli, S. D.; Gudmundsson, L.; Rotzinger, D. C.
title: Catheter-directed thrombolysis in COVID-19 pneumonia with acute PE: Thinking beyond the guidelines
date: 2020-05-08
journal: Thromb Res
DOI: 10.1016/j.thromres.2020.05.007
sha: 0e9e4609ec6c84bf2b0eda89140d7a5e5276ce71
doc_id: 849607
cord_uid: 46ohny64

• Patients having COVID-19 pneumonia are at risk of venous thromboembolism. • Prophylaxis versus anticoagulation for severely ill patients is currently debated. • No specific guidelines for the management of severe pulmonary embolism exist. • Endovascular pulmonary embolism therapy may play a critical role in severe COVID-19.

has been identified as a significant indicator of poor prognosis [2] , and recent reports attempted to understand COVID-19-related coagulopathy and raised awareness of acute pulmonary embolism (PE) events [3; 4] .

In a man in his 50s admitted due to low-grade fever, dyspnea, vomiting, and Furthermore, induced bleeding is a major concern when using aggressive therapies such as thrombolysis, and must be considered when assessing benefits and risksparticularly in intermediate-risk patients. For this reason, our team used catheterdirected ultrasound-assisted thrombolysis; this system presents promising results regarding the risk of major bleeding complications [10], at least through a reduced thrombolytic agent dose.

In conclusion, because COVID-19 pneumonia is associated with an increased thromboembolic risk, thrombosis prophylaxis is recommended for all inpatients. On the other hand, guidelines to manage patients having COVID-19 pneumonia complicated by PE with a high CT obstruction index are currently lacking. In our case, endovascular treatment was used to improve lung function efficiently because of concern related to the combined hypoxemic effects of impaired arterial perfusion and infectious lung inflammation, adding up and possibly exacerbating the clinical course of COVID-19 pneumonia. However, this strategy is not recommended by the current guidelines. Awaiting further evidence, it should necessarily receive consensus from a

with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography

Severe COVID-19 infection associated with endothelial activation

ISTH interim guidance on recognition and management of coagulopathy in COVID-19: A Comment

The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism