In patients with COVID-19, thromboinflammation is one of the main causes of morbidity and mortality, which makes anticoagulation an integral part of treatment. However, pharmacodynamic and pharmacokinetic properties of direct oral anticoagulants (DOACs) limit the use of this class of anticoagulants in COVID-19 patients due to a significant interference with antiviral agents. DOACs use in COVID-19 hospitalized patients is currently not recommended. Furthermore, patients already on oral anticoagulant drugs should be switched to heparin at hospital admission. Nevertheless, outpatients with a confirmed diagnosis of COV-ID-19 are recommended to continue prior DOAC therapy. More studies are required to clarify the pathogenesis of COVID-19-induced derangement of the coagulation system in order to recommend an appropriate anticoagulant treatment.

Heart failure with reduced ejection fraction (HFrEF) is a progressive clinical syndrome defined by changes in the myocardial structure, which lead to predominant systolic myocardial function impairment, with a left ventricle ejection of fraction ≤40%. The rehospitalization burden in HFrEF patients (pts) remains very high, with poor quality of life, increased mortality and large healthcare expenditures. In this research project, we investigated the risk factors for first and repeated hospitalization in pts with HFrEF. This retrospective study included 50 adult pts with a diagnosis of HFrEF and who were within the age range of 55 to 89 years old and of both sexes. Demographic and clinical data (HFrEF etiology, renal function parameters, complete blood count, markers of nflammation, electrocardiogram, troponin I, NTproBNP, echocardiographic parameters and comorbidities data) were collected from the pts’ medical histories. Statistical analysis was performed via Fischer’s exact test, the Shapiro-Wilk test and the Spearman correlation coefficient. This study included 70% male and 30% female HFrEF pts. Males were younger in both group of pts and had a higher incidence of rehospitalization. The most important HFrEF etiologic risk factors are arterial hypertension (82%), coronary heart disease (54%), atrial fibrillation (52%) and diabetes mellitus (40%). The most important noncardiac comorbidity related with the first HFrEF hospitalization is pneumonia (P=0.03), while progression of left ventricle systolic and diastolic dysfunction is related to rehospitalization risk (left ventricle end systolic diameter, P=0.003; diastolic dysfunction degree, P=0.04). The troponin level was associated with an increased risk of rehospitalization, but this was not statistically significant at this sample size (troponin I, p=0.10). Following the first and repeated hospitalizations of HFrEF pts, comorbidities, ageing and gender difference are crucial to HFrEF development, while echocardiographic parameters and biomarkers critically affect HFrEF rehospitalization risk.

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