Study to AntagOnize Plasminogen Activator Inhibitor-1 in Severe COVID-19

Exclusion Criteria

• •1. Age \<18 years old
• •2. Pregnancy or breast-feeding
• •3. Known contraindication to tissue plasminogen activator (tPA), including
• •1. Active internal bleeding
• •2. History of cerebrovascular accident
• •3. Recent intracranial or intraspinal surgery or trauma
• •4. Intracranial neoplasm, arteriovenous malformation or aneurysm
• •5. Known bleeding diathesis
• •6. Severe uncontrolled hypertension (SBP\>200 persistently \>12 hours)
• •4. Currently receiving therapeutic dose anticoagulation (specifically will exclude those with potential drug-drug interaction such as heparin, apixaban, warfarin)
• •5. Platelets \<50,000
• •6. Hematocrit \<30%
• •7. Not hemodynamically stable in the preceding 4 hours (symptomatic hypotension or systolic BP \<95 mmHg at 2 out of 3 measurements)
• •8. Concomitant illness, physical impairment or mental condition which in the opinion of the study team / primary care physician could interfere with the conduct of the study including outcome assessment
• •9. Other patient characteristics (not thought to be related to COVID-19) that portend a very poor prognosis (e.g., severe liver failure, metastatic malignancy)
• •10. Participation in a concurrent interventional medical investigation or pharmacologic clinical trial. Patients in observational, natural history or epidemiological studies not involving an intervention are eligible.
• •11. Participant's responsible attending physician believes it is not appropriate for participant to participate in the study.
• •12. Inability or unwillingness to provide written informed consent
• •13. Involvement in the planning and/or conduct of the study
• •14. Previous randomization in the present study
• •15. Unable to complete study procedures.
• •16. Patients with active venothromboembolic disease
• •17. Patients who are receiving other investigational agents for COVID-19.