ABSTRACT
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.
ABSTRACT
Introduction. Cerebrovascular attacks are one of the leading causes of mortality and morbidity in the world. The most severe are considered to be pontine strokes, because of the high risk of vital functions impairment. The clinical presentation of a pontine stroke can vary from the classical crossed syndrome (ipsilateral cranial nerve palsy and contralateral motor and/or sensory impairment) to pure motor hemiplegia or pure sensory stroke, which are less common.(1) Materials and methods. This presentation describes the case of a 39-year-old patient with a recent history of untreated SARS-COV 2 infection that was followed in the next month by a sudden onset of facial paralysis, dysarthria and a progressive left hemiplegia. The patient's functional status was assessed in our Neuromuscular Clinical Division and he underwent a rehabilitation program consisting of physical, occupational and speech therapies. Multidisciplinary efforts were made in order to find the underlying cause of the pontine ischemic stroke. Results. The patient had a personal history of cardiovascular disease risk factors (essential hypertension and hyperlipidaemia), without other pathological brain imagining outcomes and normal bleeding tests. The suspicion of an interatrial communication was raised. The patient managed to rapidly maintain the standing posture and to practice walking with unilateral support. At discharge, the facial paralysis and dysarthria were almost completely remitted. The left brachial extremity also showed signs of improvement, as the patient was able to perform flexion and extension movements of the fingers, wrist and forearm. Conclusion. To conclude, the patient's evolution was favourable, although the certain cause of the underlying stroke has not been clarified. The neurological complications of COVID-19 include ischemic strokes, and cases were reported in young adults too(2,3). If this were the case, prevention of further cerebrovascular attacks and their complications is necessary(1). Caution in terms of medium/long-term prophylactic anticoagulant therapy and careful control of associated cardiovascular disease risk factors has been proposed and discussed in the multidisciplinary team: rehabilitation physician, neurologist, cardiologist.