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  1. Article ; Online: Low level of plasminogen increases risk for mortality in COVID-19 patients.

    Della-Morte, David / Pacifici, Francesca / Ricordi, Camillo / Massoud, Renato / Rovella, Valentina / Proietti, Stefania / Iozzo, Mariannina / Lauro, Davide / Bernardini, Sergio / Bonassi, Stefano / Di Daniele, Nicola

    Cell death & disease

    2021  Volume 12, Issue 8, Page(s) 773

    Abstract: ... correlated with mortality in COVID-19 patients even after multiple adjustments for presence of confounding ... patients (mean age: 69.8 ± 14.3, 41.8% female). Low levels of plasminogen were significantly associated ... the association between plasminogen levels and COVID-19-related outcomes in a population of 55 infected Caucasian ...

    Abstract The pathophysiology of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and especially of its complications is still not fully understood. In fact, a very high number of patients with COVID-19 die because of thromboembolic causes. A role of plasminogen, as precursor of fibrinolysis, has been hypothesized. In this study, we aimed to investigate the association between plasminogen levels and COVID-19-related outcomes in a population of 55 infected Caucasian patients (mean age: 69.8 ± 14.3, 41.8% female). Low levels of plasminogen were significantly associated with inflammatory markers (CRP, PCT, and IL-6), markers of coagulation (D-dimer, INR, and APTT), and markers of organ dysfunctions (high fasting blood glucose and decrease in the glomerular filtration rate). A multidimensional analysis model, including the correlation of the expression of coagulation with inflammatory parameters, indicated that plasminogen tended to cluster together with IL-6, hence suggesting a common pathway of activation during disease's complication. Moreover, low levels of plasminogen strongly correlated with mortality in COVID-19 patients even after multiple adjustments for presence of confounding. These data suggest that plasminogen may play a pivotal role in controlling the complex mechanisms beyond the COVID-19 complications, and may be useful both as biomarker for prognosis and for therapeutic target against this extremely aggressive infection.
    MeSH term(s) Aged ; Aged, 80 and over ; Biomarkers/blood ; Blood Coagulation ; COVID-19/blood ; COVID-19/diagnosis ; COVID-19/mortality ; Down-Regulation ; Female ; Humans ; Inflammation Mediators/blood ; Male ; Middle Aged ; Plasminogen/analysis ; Prognosis ; Risk Assessment ; Risk Factors ; Time Factors
    Chemical Substances Biomarkers ; Inflammation Mediators ; Plasminogen (9001-91-6)
    Language English
    Publishing date 2021-08-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2541626-1
    ISSN 2041-4889 ; 2041-4889
    ISSN (online) 2041-4889
    ISSN 2041-4889
    DOI 10.1038/s41419-021-04070-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Pulmonary embolism in patients with severe COVID-19 treated with systemic low-dose thrombolytic therapy: A case series.

    Aribawa, I Gusti Ngurah Mahaalit / Ryalino, Christopher / Pradhana, Adinda Putra / Dewi, Putu Utami / Sinardja, Cyndiana Widia Dewi / Mulyantari, Ni Kadek

    International journal of critical illness and injury science

    2022  Volume 12, Issue 4, Page(s) 235–238

    Abstract: ... recombinant tissue plasminogen activator (rtPA). PE should be suspected in all COVID-19 patients with rapid ... Coronavirus disease 2019 (COVID-19) has been associated with respiratory failure and high mortality ... 19 patients who developed PE. We present five survivors aged 30-75 years old with confirmed COVID-19 ...

    Abstract Coronavirus disease 2019 (COVID-19) has been associated with respiratory failure and high mortality. Hypercoagulability and thromboembolic complications have been found in a high percentage of patients amongst which, pulmonary embolism (PE) is the most common. Currently, there are no guidelines on using thrombolysis therapy in COVID-19 patients who developed PE. We present five survivors aged 30-75 years old with confirmed COVID-19. All cases were proven by computed tomography pulmonary angiogram (CTPA) to have PE treated with low-dose recombinant tissue plasminogen activator (rtPA). PE should be suspected in all COVID-19 patients with rapid worsening of dyspnea, desaturation, unexplained shock, and increased level of D-dimer and fibrinogen. In our cases, PE developed despite preventative anticoagulation regimens with low molecular weight heparin. After thrombolytic therapy, all patients showed improvement in partial-arterial-oxygen-pressure to inspired oxygen-fraction ratio (arterial partial pressure of oxygen/inspired oxygen fraction ratio). D-dimer showed elevation after thrombolytic therapy and decreased in the following days. Fibrinogen levels decreased following thrombolytic therapy. Current anticoagulation regimens seem insufficient to halt the course of thrombosis, and thrombolytic therapy may be beneficial for patients with severe COVID-19 and PE. Systemic thrombolysis therapy is a double-edged sword, and clinicians must balance between benefit and risk of bleeding.
    Language English
    Publishing date 2022-12-26
    Publishing country India
    Document type Case Reports
    ZDB-ID 2638865-0
    ISSN 2231-5004 ; 2229-5151
    ISSN (online) 2231-5004
    ISSN 2229-5151
    DOI 10.4103/ijciis.ijciis_53_22
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Low dose peripheral systemic thrombolysis for treatment of intermediate-high risk acute pulmonary embolism: a case series.

    Charif, Fida / Khatoun, Houda / Nassar, Pierre / Jouni, Aya / Jaber, Sadek / Moussa, Malek / Choumar, Bilal / Karrowni, Wassef

    European heart journal. Case reports

    2022  Volume 6, Issue 10, Page(s) ytac417

    Abstract: ... anticoagulation.: Discussion: Intermediate-high-risk acute PE carries increased risk of mortality and ... with low bleeding risk; however it is expensive and requires expertise and human resources. Low-dose rtPA ... There after the dose of UFH was increased to reach a therapeutic level. Rapid clinical improvement and ...

    Abstract Background: The management of intermediate-high-risk acute pulmonary embolism (PE) is controversial with increasing interest in more aggressive treatment approaches than anticoagulation alone.
    Case summary: We describe the case series of four consecutive patients who presented to emergency room for acute shortness of breath. They were diagnosed with intermediate-high-risk acute PE based on the computed tomography pulmonary angiography and transthoracic echocardiography (TTE) findings and the elevated simplified PE score index. They received bolus of 5 mg thrombolytics recombinant tissue plasminogen activator (rtPA) administered through peripheral intravenous (i.v.) line followed by continuous infusion at a rate of 2 mg/h along with unfractionated heparin (UFH) at a rate of 500 mg/h for additional ≤10 h. There after the dose of UFH was increased to reach a therapeutic level. Rapid clinical improvement and also improvement in TTE parameters were noted at discharge. Patients were discharged home on oral anticoagulation.
    Discussion: Intermediate-high-risk acute PE carries increased risk of mortality and morbidities. Catheter-directed thrombolysis uses a low rtPA dose for local thrombolysis and is associated with low bleeding risk; however it is expensive and requires expertise and human resources. Low-dose rtPA through a peripheral i.v. line might be safe and effective in the treatment of patient with intermediate-high-risk acute PE. This therapeutic approach is readily available at most medical centres, can be started in the emergency room (ER), and can be alternative to catheter-directed thrombolysis nowadays during the COVID-19 era and in hospitals at the periphery and with limited resources.
    Language English
    Publishing date 2022-10-12
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytac417
    Database MEDical Literature Analysis and Retrieval System OnLINE

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