Pulmonary embolism in patients with COVID-19 pneumonia on adequate oral anticoagulation.

Thrombotic complications are common in patients with severe COVID-19 pneumonia with important consequences on the diagnostic and therapeutic management. We report a consecutive series of five patients on long-term oral anticoagulation therapy who presented to our hospital for severe COVID-19 pneumonia associated with segmental acute pulmonary embolism despite adherence to therapy and with an adequate anticoagulant range at the time of the event. Four patients were receiving a direct oral anticoagulant (two with edoxaban, one with rivaroxaban and one with apixaban) and one patient a vitamin K antagonist. No significant thrombotic risk factors, active cancer, or detectable venous thromboembolism were present. In all cases, elevated d-dimer and fibrinogen levels with a parallel rise in markers of inflammation were documented. The combination of these findings seems to support the hypothesis that considers the local vascular damage determined by severe viral infection as the main trigger of thrombi detected in the lungs, rather than emboli from peripheral veins.

[Percutaneous coronary intervention in the elderly]. / Rivascolarizzazione miocardica percutanea nel paziente anziano.

Developed countries are experiencing an unprecedented growth in the number of elderly citizens. Elderly patients represent one third of all admissions for non-ST-elevation acute coronary syndrome in the coronary care unit. Treatment is more complex due to comorbidities. The safety and efficacy of percutaneous coronary intervention in elderly patients have not been extensively studied. Despite their high-risk characteristics and worse outcomes, compared with younger patients, the elderly receive less aggressive treatments. The risk of major bleeding and renal failure are increased with percutaneous coronary intervention; in addition the functional condition remains an important concern. Revascularization in elderly patients is not to be aimed at perfection, but at functional results.