The iron deficient anaemia is a common medical condition in patients with heart failure receiving antithrombotic therapy. Especially during the COVID19 pandemic period the rate of bleeding complications associated with the antithrombotic therapy tend to be higher, as the patient’s referral to medical services is lower and the interaction doctor-patient is limited. In our retrospective observational study we included 300 consecutive patients with decompensated heat failure associating iron deficient anaemia. For defining the medical conditions we used the ESC guidelines terminology and diagnostic criteria. We assessed the association between the iron deficient anaemia and different antithrombotic therapies, recommended in concordance to ESC Guidelines. We found that aspirin 75mg/day was statistical significant associated with iron deficient anaemia (p 0.012) and anaemia severity (p 0.002), this association being assessed by Chi square and Pearson tests. Also, neither clopidogrel, ticagrelor, VKA or non-VKA were associated to the presence of anaemia. By assessing the mortality rate associated to anaemia severity, the severe anaemia was associated to higher mortality rate, meanwhile no antithrombotic therapy was associated with higher readmission or mortality rate (p<0.001). In conclusion, aspirin was the only antithrombotic therapy associated with the presence of anaemia and anaemia severity, while only severe anaemia was associated with statistic significant increase of patient’s mortality, with nonstatistical result regarding the readmission rate. This finding is concordant to the necessity of a permanent evaluation of the antithrombotic therapy in heart failure patients. Keywords: antithrombotic therapy, decompensated heart failure, iron deficient anaemia, COVID 19 pan-demic, mortality rate

The pulmonary embolism (PE) represents a medical condition with increasing incidence. The various clinical forms of PE have different prognosis, related to the presence of markers of right ventricle (RV) dysfunction (biochemical or imagistic). Material and method. In this study we included 82 consecutive patients with intermediate-high risk PE, assessing the main risk factors distribution. We divided the patients in two groups, study group - receiving thrombolytic therapy (ateplase (t-Pa)) associated to anticoagulation (unfractionated heparin (UFH)) – and control group – receiving anticoagulation alone -. The inclusion in study group was indicated by the high bleeding risk, in this group being included patients without contraindications for thrombolysis, patients without severe renal dysfunction and patients with body mass index (BMI) 18.5-29.9 kg/m2. We assessed the gender distribution in the two groups, the medium age distribution and the main PE risk factors in the two groups. Also, we assessed the effect of the both therapies on the hemodynamic instability rate on 7 day from admission (defined by systolic blood pressure (SBP) < 100 mmHg or a SBP drop >40 mmHg from inclusion value). The statistical analysis was made using SPSS program, by comparing the association between risk factors and the two groups, by Chi-squared test, while the gender and age distribution was made using the Shapiro Wilk test for the evenly data distribution and Wilk test (as the data were unevenly distributed). Results. We found no correlation between the risk factors and the study groups. There was no statistical significance regarding the gender distribution, but the medium age was higher in control group (61.82 y.o vs. 71.28 y.o, p < 0.001. Regarding the hemodynamic instability rate the Chi-squared test proved a statistical significant higher incidence in the control group (p = 0.03).

Objectives. The objective of this study is to assess the impact of the thrombolytic therapy in patients with intermediary-high risk PE. The analysis was focused on the impact on echocardiographic and biochemical markers of right ventricle (RV) pressure overload and also on mortality and haemodynamic instability. Materials and methods. In the present, study we selected patients with intermediary-high risk pulmonary embolism, selected either for thrombolytic therapy (alteplase – t-PA – plus unfractionated heparin) or for therapy only with unfractionated heparin (UFH). The patients included in the study group did not have contraindications for thrombolysis, were younger than 75 years old, did not have severe renal failure – creatinine clearance > 30 ml/min/m2 – or severe anemic syndromes – haemoglobin > 10 g/dl in thrombolysed group. The rest of the patients were included in the control group. The echocardiographic markers of right ventricle were determined on admission and on 3 days, Nt pro BNP value was assessed on admission and on 7 days as a marker of right ventricular (RV) pressure overload. As a statistical tool for comparing the evolution of the markers in the 2 groups the t-test assuming equal variances was used. Results. The right ventricle dysfunction markers were statistically significant improved in the study group treated with thrombolytic therapy and unfractionated heparine compared to patients from the group treated with unfractionated heparine alone. The thrombolytic effect on mortality was statistically insignificant but the effect on haemodynamic stability reached the statistical significance. The major bleeding rate was higher in the thrombolysed group, not being significant compared to the control group, receiving unfractionated heparine alone. Discussions. The effect of the thrombolytic therapy on biochemical and imagistic markers of RV dysfunction demonstrates the benefit of the therapy compared to classic therapy. The impact on mortality was not statistical significant but the effect on haemodynamic instability is correlated with the effect on biochemical and imagistic markers of RV dysfunction. Conclusion. The benefic effect of the thrombolytic therapy in patients with intermediary-high risk pulmonary embolism is obvious from the presented data. The most important element is the wright selection of the patients in which the risk/benefit ratio is acceptable.

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