Role of Tissue Plasminogen Activator for Diffuse Pulmonary Microemboli in Coronavirus Disease 2019 Patient

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related hypercoagulability has been of great interest in the pathophysiology of coronavirus disease 2019 (COVID-19). Many patients have clinical findings of dead-space ventilation, similar to pulmonary embolism. Herein, a patient who presented with COVID-19 pneumonia and whose condition rapidly deteriorated to respiratory failure requiring intubation is described. Tissue plasminogen activator (tPA) was administered because of concern of pulmonary microemboli, with improvement of respiratory status and extubation within 24 hours. Patients with COVID-19 infection have an increased risk of thrombus formation,(1) and the administration of tPA may benefit these patients by immediately lysing diffuse thrombi and improving gas exchange.