Anticoagulation drug may be key to subset of COVID-19 respiratory failure patients

Research is under way to test the efficacy of an anticoagulant known as tissue plasminogen activator (tPA) in COVID-19 patients suffering from acute respiratory distress syndrome (ARDS).

ARDS is a severe lung injury commonly seen in patients with critical illnesses, and recently in COVID-19 patients. The only known treatment for ARDS is supportive care in the form of oxygen and mechanical ventilation. tPA is an anticoagulant molecule which is naturally existent in the human body. The drug form was approved by the US FDA as far back as 1996 and it was indicated for use in patients experiencing heart attack, stroke and/or pulmonary embolism.

The team of researchers, comprising physicians and scientists, at Beth Israel Deaconess Medical Center (BIDMC), Massachusetts, US, came to the idea to test tPA in COVID-19 patients with ARDS because of anecdotal evidence that a subset of those patients were clotting abnormally around their catheters and intravenous lines, said Dr Michael B. Yaffe, senior author and attending surgeon in the Department of Acute Care Surgery. Yaffe said: “We suspect these patients with aggressive clotting will show the most benefit from tPA treatment, and this new clinical trial will reveal whether that’s the case.”

The team is now beginning to enroll participants in a clinical trial to evaluate tPA’s efficacy for ARDS in COVID-19 treatment. Patients enrolled into the trial are patients with COVID-19 induced ARDS admitted into BIDMC. In the pipeline are identification of biomarkers to help accurately determine which patients with ARDS are most likely to respond to tPA.

The trial comes in the wake of a report by the same team that suggested the use of tPA could reduce deaths among said group of patients. It was published as a special report in the 23 March issue of Journal of Trauma and Acute Care Surgery. [doi:10.1097/TA.0000000000002694] Since the publication of the special report, the researchers have received feedback from physicians across the US voicing their eagerness to test out tPA on their COVID-19 patients with ARDS. As tPA is already FDA-approved for use in heart attack or stroke, doctors are allowed to use it in the off-label setting.

Dr Christopher D. Barrett, study lead author and senior surgical resident at BIDMC at Massachusetts Institute of Technology, US, said it is critical to consider existing therapies that are widely available in the treatment of COVID-19. This is in light of the global pandemic beginning to oversaturate the world’s medical capacity to accommodate the victims of the new coronavirus.  

Barrett said: “If effective and safe for the treatment of ARDS in patients with COVID-19, tPA could save lives by reducing recovery time and freeing up more ventilators for other patients in need.”