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Tenecteplase With Concomitant Anticoagulation for Acute Respiratory Failure in Patients With COVID-19: A Randomized
Hooman Poor1, Kurt Yaeger2, Serina Deeba2
1Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus
|March 18, 2024
Summary
Tenecteplase, an investigational thrombolytic, may improve outcomes for patients with COVID-19 acute respiratory failure. This trial showed potential benefits in survival and reduced renal failure, though larger studies are needed.
Area of Science:
- Pulmonary Medicine
- Critical Care Medicine
- Pharmacology
Background:
- Pulmonary thrombosis and thromboembolism are key factors in COVID-19 acute respiratory failure.
- The efficacy of thrombolysis with tenecteplase in this context remains uninvestigated.
Purpose of the Study:
- To evaluate the effect of tenecteplase on patient outcomes in COVID-19 acute respiratory failure.
Main Methods:
- A randomized, controlled, double-blind, phase II trial (NCT04505592) was conducted.
- Patients with COVID-19 acute respiratory failure were randomized 2:1 to receive tenecteplase (0.25 mg/kg) or placebo, with both groups receiving therapeutic heparin for at least 72 hours.
Main Results:
- Thirteen patients were included: 8 in the tenecteplase arm and 5 in the placebo arm.
- At 28 days, 63% of the tenecteplase group were alive and free from respiratory failure versus 40% in the placebo group (p=0.43).
- Renal failure occurred in 0% of the tenecteplase group compared to 60% in the placebo group (p=0.07). Major bleeding occurred in 25% of the tenecteplase group and 20% of the placebo group.
Conclusions:
- Tenecteplase, combined with heparin, shows potential for improving outcomes in COVID-19 respiratory failure.
- The study was limited by a small sample size, necessitating larger confirmatory trials.
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