Furthermore, thrombocytopenia is common in COVID-19, and the administration of thrombolytic agents in this setting increases bleeding risk and can itself worsen the hematologic profile.82 Mechanical thrombectomy is also favoured over catheter tPA thrombolysis for patients requiring extracorporeal membrane (ECMO) oxygenation due to the increased bleeding risk associated with ECMO. 84 However, the use of smaller catheters for thrombolysis allows access through alternatives sites, such as the popliteal vein, which may be necessary for COVID-19 patients requiring prone positioning for optimal ventilation (Figure 5).