Introduction: Bronchoscopic lung biopsy (BLB) is a widely used procedure. As the world’s population is ageing, more BLBs are performed for older people with comorbidities. The aim of the study was to investigate if an older age is a risk factor for BLB related complications. Materials and Methods: A prospective study at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros klinikos was conducted. Seven hundred and eighty-six patients (male 60.6%), mean age 57 ± 16, who underwent BLB, were included. The complications that occurred due to BLB were evaluated. Bleeding and pneumothorax were classified into I° or II° grades depending on their severity. Potential determinants, which may increase the risk of complications, emphasizing on age, were analyzed. Results: Fifty-seven (7.2%) BLB-related complications occurred. There were 27 (3.4%) pneumothoraxes, and 19 (70%) of them required thoracic drainage. Thirty (3.8%) bleeding complications occurred, and four (16%) of them were severe. Higher rates of bleeding were found in the age group ≥65 years, p = 0.001. The risk of bleeding in older patients was 3.2 times higher (95% CI 1.51–6.87). Conclusions: Older age is related to a higher incidence of mild bleeding during BLB. However, the risk of life-threatening complications is low despite the age, and older age should not be considered as a contraindication for the procedure if needed.

Background: Following acute pulmonary embolism (PE), disease outcomes vary among patients. Complete recovery occurs in some cases, while others may experience persistent long-term symptoms, disease recurrence, or progression to chronic thromboembolic pulmonary hypertension (CTEPH). The exact reasons behind incomplete recovery and different outcomes are still not well established. This review aims to present the existing data regarding the clinical significance of residual thrombi after acute PE, particularly in the context of disease recurrence, the development of CTEPH, or persistent symptoms and functional limitations. Methods: Original articles, systematic reviews, and meta-analyses relevant to the topic are reviewed. Results: Incomplete thrombus resolution after acute PE is quite common, with studies showing that it affects one-fourth to one-third of PE patients, despite receiving optimal anticoagulant treatment. It has been shown that residual thrombi after acute PE play a role in the risk of PE recurrence. However, there is still no standardized method to differentiate disease recurrence from residual thrombi in pulmonary imaging studies, particularly in cases where no follow-up scans and different imaging techniques are used for thrombi detection. Residual vascular obstruction is necessary for the development of CTEPH. Evidence suggests that the extent of residual thrombi contributes to a higher risk of CTEPH. Still, there is a need to standardize both the timing of residual thrombi assessment and the evaluation of their distribution, in relation to the development of CTEPH. The significance of residual thrombi for persistent symptoms and functional limitation remains debatable. Research indicates that nearly half of patients experience long-term symptoms after acute PE. Still, it is believed that these symptoms are not necessarily caused only by residual thrombi, but rather by the worsening of other comorbid conditions. Conclusions: Studies show that residual thrombi after acute PE are significant for PE outcomes. It may be beneficial to consider evaluating residual pulmonary vascular obstruction when treating patients after acute PE to optimize the duration of anticoagulant therapy and improve patient outcomes.

Background and Objectives: Pulmonary embolism (PE) is a potentially life-threatening disease. Although anticoagulant therapy reduces the risk of recurrent PE, it increases the risk of bleeding complications. Therefore, decisions regarding treatment duration are made individually, balancing recurrent venous thromboembolism (VTE) and bleeding risk. However, the optimal duration of anticoagulant therapy after acute PE remains challenging in clinical practice. The aim of this study was to evaluate bleeding rates during anticoagulant therapy and identify possible bleeding risk factors. Materials and Methods: A prospective study was conducted at a tertiary pulmonology center within a university hospital. A total of 201 consecutive patients (50.2% male) after a first episode of acute PE were included. Bleeding complications during anticoagulant therapy were recorded at follow-up visits and classified as major and minor. Potential risk factors associated with increased bleeding risk during anticoagulant therapy were analyzed. Results: During follow-up, 35 patients (17.4%) experienced bleeding complications, including 5 (2.5%) major and 30 (14.9%) minor bleeding events. Recurrent bleeding occurred in 6 patients (17.1%). The median time to first bleeding event was 3 months (IQR 1–7.5). Patients receiving extended anticoagulation beyond 6 months experienced more frequent bleeding events, predominantly non-major bleeding; however, bleeding incidence per patient-year did not differ significantly according to treatment duration (IRR 1.26, 95% CI 0.63–2.49). Other factors associated with increased bleeding risk included prior bleeding history, PE with no identifiable provoking factor, elevated B-type natriuretic peptide (BNP) levels and high early PE mortality risk at hospitalization. Conclusions: Bleeding during anticoagulant therapy after PE was frequent, but mostly non-major. More bleeding events (non-major) were observed among patients receiving longer anticoagulation, although this difference was attenuated after adjustment for anticoagulation exposure time. Prior bleeding, unprovoked PE, and markers of more severe PE were associated with increased bleeding risk. Findings suggest that prolonged anticoagulation is safe when clinically indicated, although regular reassessment of bleeding risk remains important.