Author: Sagardia, Lisa M; Daniels, Lisa M
Title: Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19 Cord-id: 5j1em4tc Document date: 2020_8_11
ID: 5j1em4tc
Snippet: PURPOSE: Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported. SUMMARY: This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of
Document: PURPOSE: Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)–associated massive pulmonary embolism with cardiac arrest is reported. SUMMARY: This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest–associated massive pulmonary embolism after failure of previous anticoagulation efforts. CONCLUSION: Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.
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