Emory Saint Joseph's Hospital, Atlanta, GA.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Emory Saint Joseph's Hospital, Atlanta, GA.
Am J Health Syst Pharm. 2020 Nov 16;77(23):1961-1964. doi: 10.1093/ajhp/zxaa287.
Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)-associated massive pulmonary embolism with cardiac arrest is reported.
This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest-associated massive pulmonary embolism after failure of previous anticoagulation efforts.
Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.
成功使用阿替普酶和阿加曲班治疗一例新冠肺炎（COVID-19）相关的大咯血伴心跳骤停患者。
本病例报告描述了一例 42 岁男性 COVID-19 患者，在疑似低分子肝素治疗深静脉血栓形成失败后，发生了大量肺栓塞，导致心跳骤停。给予两剂 50mg 的阿替普酶静脉注射后，自主循环恢复，随后使用低剂量阿加曲班作为后续抗凝治疗，未发生并发症。这是首例在 COVID-19 患者中使用阿加曲班治疗心跳骤停相关大咯血的病例，此前抗凝治疗失败。
阿加曲班可作为 COVID-19 患者低分子肝素治疗失败后的替代抗凝策略。应权衡利弊，讨论治疗的适宜性和剂量。需要更多的数据来了解 COVID-19 患者的独特高凝状态，并进一步研究阿加曲班和比伐卢定治疗在这一患者群体中的作用。
