Combination of thrombolytic and immunosuppressive therapy for coronavirus disease 2019: A case report

Papamichalis, Panagiotis; Papadogoulas, Antonios; Katsiafylloudis, Periklis; Skoura, Apostolia-Lemonia; Papamichalis, Michail; Neou, Evangelia; Papadopoulos, Dimitrios; Karagiannis, Spyridon; Zafeiridis, Tilemachos; Babalis, Dimitris; Komnos, Apostolos

In a proportion of patients Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes a multi-systematic syndrome characterized by hyperinflammation, Acute Respiratory Distress Syndrome (ARDS) and hypercoagulability. A 68-year-old man with Coronavirus Disease 2019 (COVID-19) presented in our Intensive Care Unit (ICU) with respiratory failure, Cytokine Release Syndrome (CRS) and skin ischemia – microthrombosis. Specific coagulation and inflammatory markers (D-dimer, ferritin and C-reactive protein) along with the clinical picture triggered the trial of recombinant tissue plasminogen activator (rt-PA) and Tocilizumab. This was followed by resolution of skin ischemia and CRS while respiratory parameters improved. No major complications associated with rt-PA or Tocilizumab occurred. Combination of rt-PA with targeted anti-inflammatory treatment could be a new therapeutic option for patients with COVID-19, ARDS, hyperinflammation and increased blood viscosity.