Background Thrombocytopenia (TP) is associated with higher incidence of bleeding in the setting of percutaneous coronary intervention (PCI) leading to increased morbidity and mortality. Herein, we report a meta‐analysis evaluating the effects of baseline thrombocytopenia (bTP) on cardiovascular outcomes in patients undergoing PCI. Methods Literature search was performed using PubMed, Embase, Cochrane library and http://clinicaltrials.gov from inception till October 2019. Patients were divided into two groups: Patients with (a) no Thrombocytopenia (nTP) (b) bTP before PCI. Primary endpoints were in‐hospital, and all‐cause mortality rates at the longest follow‐up. The main summary estimate was random effects risk ratio (RR) with 95% confidence intervals (CIs). Results A total of 6,51,543 patients from 10 retrospective studies were included. There was increased in‐hospital all‐cause mortality (RR 2.58 [1.7–3.8], p < .001) and bleeding (RR 2.37 [1.41–3.98], p < .005), in the bTP group compared to the nTP group. There was no difference for in‐hopsital major adverse cardiovascular outcomes (MACE) (RR 1.38 [0.94–2.0], p < .10), post‐PCI MI (RR 1.17 [0.9–1.5], p = .19) and TVR (RR 1.65 [0.8–3.6], p = .21), respectively. Outcomes at longest follow‐up showed increased incidence of all‐cause mortality (RR 1.86 [1.2–2.9], p < .006) and bleeding (RR 1.72 [1.1–2.9], p = .04) in bTP group, while there was no significant difference for post‐PCI MI (RR 1.07 [0.91–1.3], p = .42), MACE (RR 1.86 [0.69–1.8], p = .68) and TVR (RR 1.1 [0.9–1.2], p = .93) between both groups. Conclusions bTP in patients undergoing PCI is associated with increased mortality and predicts risk of bleeding.

In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic and its associated mortality and virulence, a high clinical suspicion must be maintained for all patients presenting with respiratory failure. However, there are well-known disease processes that may have a similar presentation. We present a case of a 25-year-old male who suffered a right tibia fracture after a motor vehicle collision. He had acute hypoxic respiratory failure within 24 hours of admission, requiring mechanical ventilation. His condition significantly improved with airway pressure release mode of ventilation and proning. Although his chest CT demonstrated characteristic findings of COVID-19, he subsequently tested negative. The differential included aspiration pneumonia and fat embolism syndrome from the lower extremity fracture. Fat embolism syndrome can very closely mimic COVID-19. The rapid onset and improvement of symptoms coupled with serial negative COVID-19 testing may aid in the diagnosis.

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