Pulmonary embolism in patients with COVID-19 pneumonia: When we have to search for it?

BACKGROUND: COVID-19 is still a global challenge in regard for management and therapy. Pulmonary embolism (PE) seems to have a higher prevalence in COVID-19 instead of non-COVID patients. Clinical and laboratory parameters related with PE are still unknown. METHODS: We conducted a retrospective unicentre study in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 in patients admitted for COVID-19 tested with a RT-PCR nasal swab. Data about patients studied with computed tomography pulmonary angiogram (CTPA) because of PE suspicion were collected, as their clinical and laboratory parameters too. RESULTS: 2621 patients were admitted for COVID-19 in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 and in 267 of them a CTPA was performed finding 50 PE (18.7%). Only non-Caucasian race (OR = 5.44; 95% CI 1.22-24.35; p = 0.027) and previous VTE (OR = 5.3; 95% CI 1.09-26.17; p = 0.039) were found to be independently associated with PE. CONCLUSION: PE is a frequent complication of COVID-19 and clinician need high degree of suspicion because clinical and laboratoristic parameters cannot drive diagnosis.

Occult atherosclerosis and physical vascular examination: a simple strategy to avoid inadequate cardiovascular prevention and under-use of diagnostic vascular guidelines in outpatients. A multicenter study by Angiology Care Units in North-Eastern Italy.

AIM: Recent studies show a high prevalence of inadequate secondary prevention in a subset of the US population at highest risk for stroke and acute myocardial infarction. METHODS: The present investigation evaluated subjects older than 50 years of age attending four Angiology Care Units in Northern Italy. The adequacy of risk factor (hypertension, body weight, cigarette smoking and hypercholesterolemia) control was in particular analyzed, and a search was made for occult atherosclerotic lesions during a thorough physical examination. Finally, adherence to diagnostic vascular guidelines was also evaluated. RESULTS: Twenty-two percent out of 483 patients enrolled in this study were found to have unexpected atherosclerotic lesions, 61.9% of the patients with a history of hypertension, 10.6% showed an inadequate control of blood pressure levels, 55% presented poor lipid control, 16.6% had not stopped smoking and 45.7% were overweight. The physical examination revealed that 13.8% of the patients had cervical bruits, 6.3% had aortic hyperpulsatility and 8.5% were lacking lower limb pulses, not previously diagnosed. It was found that in almost half of the participating patients diagnostic vascular guidelines were not being followed. CONCLUSION: This study shows a high prevalence of inadequate primary and secondary prevention and under-use of diagnostic vascular guidelines in the care of high-risk patients (older than 50 years with diabetes, smokers, etc.). Considerable efforts are required to effectively implement risk factor modification strategies and, with regard to Angiology Care Units, to correctly search for occult atherosclerotic lesions in high-risk patients.