New Treatment Approach Proposed for Respiratory Distress in COVID-19

Research suggests that repurposing a drug used to treat blood clots may help patients with severe COVID-19 in acute respiratory distress, according to a new paper published in the Journal of Trauma and Acute Care Surgery.

The drug, a protein called tissue plasminogen activator (tPA), which is used to treat patients with heart attack and stroke, may serve as an alternative approach in cases where a ventilator is not helping or is unavailable.

In the paper, researchers at Massachusetts Institute of Technology (MIT) and the University of Colorado at Denver proposed the approach to use tPA in patients with COVID-19 who are in acute respiratory distress. According to the authors, the approach is based on findings that indicate the formation of blood clots in the lungs of patients with respiratory failure. In these cases, small blood clots can also form in the blood vessels of the lungs, and can prevent blood from reaching the airspaces.

Similar pathologic findings have been observed in lung specimens from patients infected with COVID-19, the authors wrote. Another clue that patients with COVID-19 may benefit is the presence of inflammation-linked tissue damage observed in autopsy results from those patients, which may contribute to clot formation, according to the paper. 

In one human study conducted in 2001, patients who were in respiratory failure following trauma or sepsis were given drugs that active plasminogen. All of the patients had severe respiratory distress and were not expected to survive; however, 30% of them survived following treatment.

“What we are hearing from our intensive care colleagues in Europe and in New York is that many of the critically ill patients with COVID-19 are hypercoagulable, meaning that they are clotting off their IVs, and having kidney and heart failure from blood clots, in addition to lung failure,” author Michael Yaffe, a David H. Koch Professor of Science at MIT said in a press release. “We don’t have to make a new drug, and we don’t have to do the same kind of testing that you would have to do with a new agent. This is a drug that we already use. We’re just trying to repurpose it.”

According to Yaffe, if this approach were to prove effective, it could be scaled up quickly since every hospital already has it in their pharmacy.

“Extraordinary times may call for extraordinary measures,” the authors wrote in the paper. “If an observational trial of this treatment in the first series of patients is safe and effective, the approach could be readily broadened.”

The hospitals planning to test this approach are Beth Israel Deaconess, the University of Colorado Anschultz Medical Campus, and Denver Health.

References:

1. Moore HB, Barrett CD, Moore EE, et al. Is there a role for tissue plasminogen activator (tPA) as a novel treatment for refractory COVID-19 associated acute respiratory distress syndrome (ARDS). Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000002694

2. A stopgap measure to treat respiratory distress [news release]. MIT’s website. http://news.mit.edu/2020/covid-19-treat-respiratory-patients-plasminogen-0324. Accessed March 26, 2020.