Thromboembolism is the leading cause of mortality in COVID-19 patients. Thrombi, including pulmonary embolism (PE) and deep vein thrombosis (DVT), range from minor sequelae to fatal complications of SARS-CoV-2 infection [1]. Individuals with pre-existing conditions are more likely to develop thrombi and have poor outcomes [2]. The guidelines from professional societies for the use of fibrinolytic therapy (FT) in COVID-19 are inconsistent [3]. The outcomes of FT for ARDS (acute respiratory distress syndrome) associated with COVID-19 have not been clarified to date. We have summarized 105 COVID-19 patients treated with alteplase (tPA). tPA was applied for thrombolytic (fibrinolytic, generally after the failure of heparin), salvage (rescue for gravely ill patients), or prophylactic therapies for those with a potential of thrombosis [4]. We have compared the morbidity, mortality, complications, laboratory tests of COVID-19 patients with ARDS versus those without ARDS (non-ARDS), and adverse events of fibrinolytic therapy.

This pooled study aimed to summarize all reported case series of fibrinolytic therapy for COVID-19. IRB approval and informed consent were not required. Clinical features of all 105 individual cases are presented in Table 1, and additional details are shown in the online supplement. Outcomes were ICU admission, discharge to the general ward, in-hospital death, or discharge home. One-Way ANOVA for continuous variables and χ2 tests for categorical variables were conducted using R (v4.0.3) and Prism 9 with a two-sided level of significance P < 0.05. The results were graphed using the ggplot2 package.

Table 1 Comparison of ARDS and non-ARDS patients treated with tPA.
Full size table

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