Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the novel pathogen responsible for the coronavirus disease 19 (COVID-19) outbreak. Researchers and clinicians are exploring the pathogenetic mechanisms of the viral-induced damage and growing interest is focusing on the short-term and long-term immune-mediated consequences triggered by the infection. We will focus on post-SARS-CoV2 infection arthritis which may arise as a new pathological condition associated with COVID-19. In this article, we describe a case of acute oligoarthritis occurring 13 days after a SARS-CoV2 severe pneumonia in a middle-aged Caucasian man and we go over a brief review of the current available literature. We hypothesize that molecular mimicry might be the basic immunological mechanism responsible for the onset of COVID-19-related arthritis based on the current knowledge of SARS-CoV2 and on the known pathogenetic mechanism of viral-induced arthritis.

Although there is emerging evidence that bleeding is a strong predictor of mortality in patients with acute arterial thrombosis receiving antithrombotic therapy [1][2][3], whether a similar association between bleeding and mortality also exists in patients with venous thromboembolism (VTE) has not been thoroughly investigated. In a recent systematic review of randomized trials addressing the value of fondaparinux for prevention of VTE in high-risk surgical or medical patients, Eikelboom et al. [4] were able to confirm this association. Comparable results were obtained in a large series of patients who had received antithrombotic drugs for the treatment of VTE in a community setting [5]. Recently, Nieto et al. [6] reported a high mortality rate in the follow-up of 407 patients, who belonged to the RIETE registry and had developed major bleeding while on conventional anticoagulation. However, in this study no attempt was made to compare the mortality rate between patients who bled and those who did not, and nor were study results adjusted for potential confounders. We describe here the association between major bleeding and mortality after the enrollment of almost 30 000 patients with acute VTE in the multicenter RIETE registry.Between March 2001 and December 2009, 29 903 consecutive patients with acute VTE, as confirmed by objective tests, were enrolled in the RIETE registry, received conventional anticoagulation, and were followed up for 3 months (80% of the study cohort) or longer periods of time after the index episode. Bleeding complications were classified as major if they were overt and required a transfusion of at least two units of blood, were retroperitoneal, spinal or intracranial, or were immediately (within 24 h) fatal [6]. The primary study aim was to compare the overall risk of death occurring during the follow-up between patients who bled and those who did not.The baseline characteristics of patients who bled and those who did not were compared with the use of the chi-square test for categorical variables and the Student t-test for continuous variables. All variables possibly associated with bleeding (P < 0.10 after univariate analysis) were included in the model, and Cox proportional hazards regression analyses were used to examine the association between patientsÕ demographic, clinical and treatment characteristics and major bleeding. Cox proportional hazards regression analyses were used to examine the association between baseline and treatment characteristics and death, with major bleeding as a timedependent covariate. All P-values were two-sided and were considered to be statistically significant at the 5% level.

Venous thromboembolism (VTE) prophylaxis in high-risk patients is frequently underutilised. We previously devised a one-screen computer alert program that identified hospitalised patients at high risk for VTE who were not receiving prophylaxis and advised their physicians to prescribe prophylaxis. While this strategy reduced the 90-day incidence of symptomatic VTE by 41%, the majority of electronic alerts were ignored. We have now developed a serial three-screen alert computer program designed to educate physicians who initially declined to order prophylaxis after a single screen alert. Of a total cohort of 880, the responsible physicians for 425 patients received a single electronic alert, whereas 455 who declined prophylaxis after the first screen received the second and third screens of the novel three-screen alert. Our enhanced serial three-screen alert program generated VTE prophylaxis orders for 58.4% of the 455 patients whose physicians initially declined to order prophylaxis following the one-screen alert. There was no significant difference in symptomatic 90-day VTE rates between the two cohorts (2.8% for the one-screen vs. 2.2% for the three-screen, p=0.55). We conclude that our three-screen computer alert program can markedly increase prophylaxis among physicians who decline an initial single screen alert.

Stratification of the individual bleeding risk prior to initiation of anticoagulation in patients with acute venous thromboembolism (VTE) has the potential to assist clinicians in making decisions about the proper intensity and duration of antithrombotic therapy. It is unclear which of the validated and internationally accepted scores recommended for the achievement of this important task has the best predictive value. We compared the predictive value of four validated scores (by Landefeld, Beyth, Kuijer and Ruiz-Gimenez, respectively) for the development of major bleeding complications occurring in the first 3 months in patients with acute VTE treated with conventional anticoagulation. Based on the population of RIETE Registry (international registry of patients with acute VTE), we identified those patients presenting all the required prognostic variables, and then calculated the ability of each score for predicting the bleeding risk. Of 40,265 eligible patients, we identified 8,717 meeting the recruitment criteria. Overall, 0.9 % of patients experienced at least one episode of major bleeding within 90 days of the index event. The proportion of patients classified as having a low risk varied between 1.2 and 3.7 %, that of patients having an intermediate risk between 76 and 93 %, and that of patients classified as having a high risk between 6.1 and 18 %. The area under the receiver operating characteristic ranged between 0.55 and 0.60, the positive predictive value between 1.5 and 3.2, and the likelihood ratio between 0.72 and 1.59. In conclusion, all four scores show a very low ability to predict the bleeding risk in patients with acute VTE undergoing conventional anticoagulation.

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