High Risk Pulmonary Embolism in a Patient with Covid-19Pneumonia Treated With Tissue Plasminogen Activator in theEmergency Department: A Case Report and Literature Review

Abstract

Introduction: SARS-CoV2, responsible for the current global pandemic, could predispose to a hypercoagulable state. Venous thrombosis is more frequent in COVID-19 associated coagulopathy than in bacterial sepsis-induced coagulopathy. Also, COVID-19 induces and hypercoagulation state that overlaps with a hemophagocytic syndrome, antiphospholipid syndrome, and thrombotic microangiopathy. It is not uncommon that patients with severe COVID-19 consult in the emergency department with embolisms that may result in life risk. 

Materials and Methods: a 77-year-old man, with a history of 4 days of dry cough and dyspnoea became hemodynamically unstable, with an RT-PCR assay of nasopharyngeal swab positive for COVID-19 and a high-risk pulmonary embolism in the CT pulmonary angiography. He received treatment with tissue plasminogen activator and dexamethasone. The patient evolved favorably, without the need for therapeutic management in the intensive care unit.

Results: We conducted a review of the literature regarding the COVID-19 associated coagulopathy and systemic thrombolysis. 

Discussion: despite other published series, the treatment with fibrinolysis in our report resulted in better respiratory outcomes and survival. The European Society of Cardiology suggests that the treatment of COVID-19 patients with pulmonary embolism should be guided by risk stratifications according to the current guidelines. For that reason, patients with high-risk pulmonary embolism should receive systemic thrombolysis if there is not any contraindication.