{"id":22398,"date":"2022-09-12T05:24:00","date_gmt":"2022-09-11T21:24:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22398"},"modified":"2022-09-12T11:15:58","modified_gmt":"2022-09-12T03:15:58","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8e%bb%e7%ba%a4%e8%8b%b7%e6%b2%bb%e7%96%97%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8eards","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22398","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u53bb\u7ea4\u82f7\u6cbb\u7597\u65b0\u51a0\u80ba\u708eARDS"},"content":{"rendered":"\n

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 162, ISSUE 2<\/a>, P346-355, AUGUST 01, 2022<\/p>\n\n\n\n

Defibrotide Therapy for SARS-CoV-2 ARDS<\/h1>\n\n\n\n

David Frame, Gianni B. Scappaticci, Thomas M. Braun, et al<\/h3>\n\n\n\n

Chest 2022; 162: 346-355 Published:April 08, 2022<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/j.chest.2022.03.046<\/a><\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

SARS-CoV-2-related ARDS is associated with endothelial dysfunction and profound dysregulation of the thrombotic-fibrinolytic pathway. Defibrotide is a polyanionic compound with fibrinolytic, antithrombotic, and antiinflammatory properties.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

What is the safety and tolerability of defibrotide in patients with severe SARS-CoV-2 infections?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

We report a prospective, open-label, single-center safety trial of defibrotide for the management of SARS-CoV-2-related ARDS. Eligible participants were 18 years of age or older with clinical and radiographic signs of ARDS, no signs of active bleeding, a serum D-dimer of more than twice upper limit of normal, and positive polymerase chain reaction-based results for SARS-CoV-2. Defibrotide (6.25 mg\/kg\/dose IV q6h) was administered for a planned 7-day course, with serum D-dimer levels and respiratory function monitored daily during therapy.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

Twelve patients (median age, 63 years) were treated, with 10 patients receiving mechanical ventilation and 6 receiving vasopressor support at study entry. The median D-dimer was 3.25 \u03bcg\/ml (range, 1.33-12.3) at study entry. The median duration of therapy was 7\u00a0days. No hemorrhagic or thrombotic complications occurred during therapy. No other adverse events attributable to defibrotide were noted. Four patients met the day 7 pulmonary response parameter, all four showing a decrease in serum D-dimer levels within the initial 72\u00a0h of defibrotide therapy. Three patients died of progressive pulmonary disease 11, 17, and 34\u00a0days after study entry. Nine patients (75%) remain alive 64 to 174\u00a0days after initiation of defibrotide. Day 30 all-cause mortality was 17%\u00a0(95%\u00a0CI, 0%-35%). All patients with a baseline Pao2<\/sub>\u00a0to Fio2<\/sub>\u00a0ratio of\u00a0\u2265 125\u00a0mm\u00a0Hg survived, whereas the three patients with a baseline Pao2<\/sub>\u00a0to Fio2<\/sub>\u00a0ratio of\u00a0< 125\u00a0mm\u00a0Hg died.<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

The use of defibrotide for management of SARS-CoV-2-related ARDS proved safe and tolerable. No hemorrhagic or thrombotic complications were reported during therapy, with promising outcomes in a patient population with a historically high mortality rate.<\/p>\n\n\n\n

Trial Registry<\/h3>\n\n\n\n

ClinicalTrials.gov; No.: NCT04530604<\/a>; URL: www.clinicaltrials.gov<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 162, ISSU […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22398"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22398"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22398\/revisions"}],"predecessor-version":[{"id":22598,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22398\/revisions\/22598"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22398"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22398"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}