The use of fibrinolytic therapy has been proposed in severe acute respiratory distress
syndrome (ARDS). During the COVID-19 pandemic, anticoagulation has received special
attention due to the frequent findings of microthrombi and fibrin deposits in the
lungs and other organs. Therefore, the use of fibrinolysis has been regarded as a
potential rescue therapy in these patients. In this prospective meta-analysis, we
plan to synthesise evidence from ongoing clinical trials and thus assess whether fibrinolytic
therapy can improve the ventilation/perfusion ratio in patients with severe COVID-19-caused
ARDS as compared with standard of care.This protocol was registered in PROSPERO. All
randomised controlled trials and prospective observational trials that compare fibrinolytic
therapy with standard of care in adult patients with COVID-19 and define their primary
or secondary outcome as improvement in oxygenation and/or gas exchange, or mortality
will be considered eligible. Safety outcomes will include bleeding event rate and
requirement for transfusion. Our search on 25 January 2022 identified five eligible
ongoing clinical trials. A formal search of MEDLINE (via PubMed), Embase, CENTRAL
will be performed every month to identify published results and to search for further
trials that meet our eligibility criteria.This could be the first qualitative and
quantitative synthesis summarising evidence of the efficacy and safety of fibrinolytic
therapy in critically ill patients with COVID-19. We plan to publish our results in
peer-reviewed journals.CRD42021285281.
