Defibrotide Therapy for SARS-CoV2 (COVID-19) Acute Respiratory Distress Syndrome (ARDS)

Exclusion Criteria

• •Concomitant use of heparin, systemic anticoagulants, and/or fibrinolytics are not permitted within 12 hours, with the exception of heparin flushes for centrally placed catheters, fibrinolytic instillation for central venous line occlusion, or in the in-flow circuit for patients on continuous veno-venous hemodialysis.
• •Clinically significant acute bleeding, including (but not limited to one of the following): pulmonary hemorrhage (diffuse alveolar hemorrhage), intracranial bleed, gastro-intestinal hemorrhage (gross hematemesis or hematochezia), gross hematuria or uncontrolled epistaxis irrespective of the amount of blood loss, within the prior 3 days.
• •On mechanical ventilation for \> 96 consecutive hours.
• •Serum platelet count \< 50,000/Microliters (uL). Transfusion of platelets to achieve a level \> 50,000/uL is not allowed for eligibility.
• •Serum fibrinogen \< 150 mg/dl. Transfusion of fresh frozen plasma or cryoprecipitate to achieve a level \> 150 mg/dl is not allowed for eligibility.
• •Positive blood culture for a bacterial pathogen within the prior 24 hours prior to study entry, and/or the presence of bacterial pneumonia.
• •Hemodynamic instability as defined by a requirement for 2 or more vasopressors (not including renal-doses of dopamine).
• •Concurrent use of Extracorporeal membrane oxygenation (ECMO).
• •Patients with a previously known hypersensitivity reaction to defibrotide, or any of its excipients.
• •Females who are pregnant or breastfeeding.
• •History of cerebrovascular accident (i.e. thrombotic or hemorrhagic stroke) within 3 months prior to study entry.