Research Article
Volume 9 Issue 7 - 2020
Catheter Directed Thrombolysis in Patient with COVID-19 Pneumonia and Acute High-Risk Pulmonary Embolism
Mert Dumantepe1*, Hacer Kuzu Okur2, Emre Sahillioğlu3, Murat Okten1, Nalan Karadag4, Alper Ozkan4, Yasemin Gundogdu5, Selim Isbir1 and Hasan Karabulut1
1Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey
2Department of Pulmonary Medicine, Acibadem Altunizade Hospital,Turkey
3Department of Anesthesiology, Acibadem Altunizade Hospital, Istanbul, Turkey
4Department of Cardiology, Acibadem Altunizade Hospital, Istanbul, Turkey
5Department of Internal Medicine, Acibadem Altunizade Hospital, Istanbul, Turkey
*Corresponding Author: Mert Dumantepe, Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey.
Received: May 28, 2020; Published: June 29, 2020




Abstract

Background: Coronavirus disease 19 (COVID-19) is a worldwide infection which was recently declared a global health emergency by the WHO Emergency Committee. The effects of severe illness, hypoxia and microangiopathy may predispose patients to Venous Thromboembolism (VTE) events in COVID-19. However, the incidence is VTE in COVID-19 infected patients is still unknown.

Methods: We studied consecutive symptomatic patients with proven COVID-19 infection admitted to Acibadem University Hospital in Istanbul, Turkey (15.3.2020 - 15.05.2020). The primary outcome was any venous thromboembolic complications and secondary outcome was analyze rates of subsegmental Pulmonary Embolism (PE) with or without deep vein thrombosis.

Results: We included 358 consecutive patients with laboratory proven COVID-19 pneumonia. Mean age was 54.3 ± 17.4 years (range, 36 to 81 years), and 226 (63.1%) were men. A total of 77 (21.5%) patients required intensive care unit (ICU) admission; the remaining 281 (78.5%) patients were admitted to general wards. Of those patients, 13 (3.6%) were died, 319 (89.2%) were discharged alive and 26 (7.2%) were still in the hospital on May 15th 2020. VTE events occurred in 61 of 352 patients for the cumulative rate of 17% during the study period. Surprisingly, we found that 22 of 25 (88%) subsegmental PE patients have no proven deep vein thrombosis, which is corroborated the pulmonary immuno-thrombosis theory.

Conclusion: The high incidence of VTE events suggests an important role of COVID-19 induced coagulopathy. Thus, repeated assessment and optimized treatment are necessary to reduce the occurrence of VTE and prevent fatal PE events. Our retrospective study demonstrates successful results of patients with high-risk PE using EKOSÔ APT treatment. Although patients have COVID-19 infection, interventional treatment modalities demonstrate safe, promising and reproducible results.

Keywords: COVID-19; Acoustic Pulse Thrombolysis, Anticoagulation; Pulmonary Embolism; Venous Thromboembolism; VA-ECMO

References

  1. Guan WJ., et al. “China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China”. The New England Journal of Medicine (2020).
  2. Klok FA., et al. “Incidence of thrombotic complications in critically ill ICU patients with COVID-19”. Thrombosis Research (2020).
  3. Wang T., et al. “Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19”. The Lancet Haematology (2020).
  4. Wang J., et al. “Tissue Plasminogen Activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series”. Journal of Thrombosis and Haemostasis (2020).
  5. Tang N., et al. “Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy”. Journal of Thrombosis and Haemostasis (2020).
  6. N Zhu., et al. “China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019”. The New England Journal of Medicine 382 (2020): 727-733.
  7. Chen N., et al. “Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study”. Lancet 10223 (2020): 507-513.
  8. Middeldorp S., et al. “Incidence of venous thromboembolism in hospitalized patients with COVID-19”. Journal of Thrombosis and Haemostasis (2020).
  9. The GUSTO Angiographic Investigators. “The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction”. The New England Journal of Medicine 22 (1993): 1615-1622.
  10. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when novel coronavirus (2019-nCoV) infection is suspected (Interim guidance Version 1.2) (2020).
  11. Mei H and Hu Y. “Characteristics, causes, diagnosis and treatment of coagulation dysfunction in patients with COVID-19”. Zhonghua Xue Ye Xue Za Zhi= Zhonghua Xueyexue Zazhi 41 (2020): E002.
  12. Obi AT., et al. “Empirical systemic anticoagulation is associated with decreased venous thromboembolism in critically ill influenza A H1N1 acute respiratory distress syndrome patients”. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 7 (2019): 317-324.
  13. Chong PY., et al. “Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis”. Archives of Pathology and Laboratory Medicine 2 (2004): 195-204.
  14. Zhou F., et al. “Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study”. Lancet 395 (2020): 1054-1062.
  15. Tang N., et al. “Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy”. Journal of Thrombosis and Haemostasis (2020).
  16. Wichmann D., et al. “Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study”. Annals of Internal Medicine (2020).
  17. Simpson S., et al. “Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA”. Radiology: Cardiothoracic Imaging 2 (2020): e200152.
  18. Pulmonary Embolism and Pulmonary Vascular Diseases Group of Chinese Thoracic Society, Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians, National Cooperation Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease. “Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism”. Zhonghua Yi Xue Za Zhi14 (2018): 1060-1087.
  19. Guidelines for the Prevention and Treatment of Thrombotic Diseases in China issued by expert committee. Guidelines for the Prevention and Treatment of Thrombotic Diseases in China”. Zhonghua Yi Xue Za Zhi 36 (2018): 2861-2888.
  20. Konstantinides SV., et al. “ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)”. European Heart Journal 04 (2020): 543-603.
  21. Engelhardt TC., et al. “Catheter directed ultrasound-accelerated thrombolysis for the treatment of acute pulmonary embolism”. Thrombosis Research 128 (2011): 149-154.
  22. Dumantepe M., et al. “Improvements in pulmonary artery pressure and right ventricular function after ultrasound-accelerated catheter-directed thrombolysis for the treatment of pulmonary embolism”. Journal of Cardiac Surgery 4 (2014): 455-463.
Citation: Mert Dumantepe., et al. “Catheter Directed Thrombolysis in Patient with COVID-19 Pneumonia and Acute High-Risk Pulmonary Embolism”. EC Pulmonology and Respiratory Medicine 9.7 (2020): 129-138.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


July Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the July issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for August Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the August issue of respective journals. Submissions are accepted on/before July 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk