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Sildenafil in Acute Pulmonary Thrombosis Associated with COVID-19. Experience of a Tertiary London Hospital
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1277565
ABSTRACT
RATIONALE25 percent of all cases admitted with SARS-COV2 pneumonia are complicated by pulmonary embolism(PE) or in situ thrombosis1 .This is a major predictor for poorer outcome with acute lung injury (ALI). If the thrombotic burden is significant enough to cause right ventricular strain, even “intermediate-high risk”, normotensive patients have a 13% risk of death at three months. Current trials do not support thrombolysis in this group due to excess risk of bleeding. We are narrating our experience of using Sildenafil in patients admitted with SARS-CoV 2 Pneumonia associated ALI ,who developed acute right ventricular (RV) dysfunction and or pulmonary hypertension(PH) secondary to acute sub massive PE/insitu thrombosis.

METHOD:

Patients who were admitted to intensive care due to SARS-COV 2 related infection and diagnosed as having PE/insitu thrombosis on computed tomographic pulmonary angiography were evaluated with transthoracic echocardiography . Those who developed acute RV dysfunction and or acute PH were started on Sildenafil at an initial dose of 25 mg TDS which was increased to 50mg TDS if possible after 48 hours. The dose was adjusted depending on tolerability in terms of blood pressure, renal function or other e.g. retroviral therapies . All survivors were followed up with repeat transthoracic echocardiography at three months. Sildenafil was discontinued. in those whose pulmonary artery pressure and RV dysfunction had normalized

RESULTS:

23 out of 44 consecutive patients referred to our specialist team had evidence of PH (18 ) and/or RV dilatation (10) or dysfunction (6 ;TAPSE < 1.7 cm ) . Eight patients died in hospital . At three months,12/15 survivors had no evidence of PH or RV dysfunction and sildenafil was stopped. Three had RV dilatation, none of these had RV dysfunction (TAPSE < 1.7). No side effects associated with sildenafil were reported .

CONCLUSION:

Having experience of using sildenafil in patients with PE we believed that it would have a role in COVID-19 associated in situ thrombosis/PE particularly given the small peripheral vessels involved. The drug was well tolerated and much less labour intensive to administer than nebulized vasodilator therapies. Eighty percent of survivors had no evidence of PH/RV dilatation at three months .We believe that our encouraging experience suggests that sildenafil may have a role in acute pulmonary thrombosis and PH associated with COVID-19 and that further studies are required to address this .

Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Idioma: Inglês Revista: American Journal of Respiratory and Critical Care Medicine Ano de publicação: 2021 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados de organismos internacionais Base de dados: EMBASE Idioma: Inglês Revista: American Journal of Respiratory and Critical Care Medicine Ano de publicação: 2021 Tipo de documento: Artigo