Clinical presentation and outcome of venous thromboembolism in COPD

Bertoletti, Laurent; Quenet, Sara; Mismetti, Patrick; Hernandez, Lauren; Martín-Villasclaras, Juan José; Tolosa, Carles; Valdés, Mariano; Barrón, M.; Todolí, José; Monréal, Manuel; Investigators, Riete

doi:10.1183/09031936.00058811

Cited by 94 publications

(89 citation statements)

References 42 publications

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“…Data from clinical registries have shown that PE presents more frequently than DVT in patients with COPD [31] or asthma [32]. Accordingly, we observed higher risk estimates of PE than DVT in subjects with severe COPD.…”

Section: Discussionsupporting

confidence: 46%

“…Awareness of a high prevalence of PE in hospitalised COPD patients among clinicians [1,10], may entail a preponderance to impose diagnostic procedures for detecting this disease. Presence of detection bias would lead to an overestimation of the association and could potentially explain the higher risk estimates for nonvalidated PEs observed in the registry-based studies [11][12][13][14] compared to our study and clinical registries [31,32]. Moreover, detection bias could also partly explain the strong association of COPD with PE rather than with DVT as found in most studies.…”

Section: Discussionmentioning

confidence: 58%

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COPD and risk of venous thromboembolism and mortality in a general population

et al. 2015

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The relationship between chronic obstructive pulmonary disease (COPD) and risk of venous thromboembolism (VTE) has been scarcely studied in the general population. We aimed to investigate the association between COPD and risk of VTE and mortality in a population-based cohort.Spirometry was conducted in 8646 males and females, participating in the fifth (2001-02) and sixth (2007-08) surveys of the Tromsø Study. Incident VTE events during follow-up were registered from the date of inclusion to December 31, 2011. Cox-regression models with COPD stages and confounders as time varying covariates were used to calculate hazard ratios with 95% confidence intervals for VTE and all-cause mortality.During a median follow-up of 6.2 years, 215 subjects developed VTE. Subjects with COPD stage III/IV had a two-fold higher risk of secondary VTE compared to subjects with normal airflow (HR 2.05, 95% CI 1.02-4.10). COPD patients, particularly those with stage III/IV disease, with VTE had a higher mortality rate than COPD patients without VTE (50.2% versus 5.6% per year).Our findings suggest that patients with severe COPD may have increased risk of secondary VTE, and that COPD patients with VTE have a higher mortality rate than COPD patients without VTE. @ERSpublications Patients with severe COPD may have increased risk of VTE: VTE is associated with a worse prognosis in COPD patients

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 58%

COPD and risk of venous thromboembolism and mortality in a general population

et al. 2015

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“…COPD patients exposed to PE events are usually old and obese male patients [18] but no real specific phenotype has been identified. Our results are confident to those of Tillie-Leblond et al [12] showing that exacerbated COPD with PE had significantly higher clinical scores (Geneva and/or Wells) and D-Dimer values than patients without PE.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism in Patients Hospitalized for Exacerbated COPD and Wheezing

Woimant¹

2015

J Pulm Respir Med

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“…3 Compared to non-COPD patients the three month prognosis in patients with COPD and PE was worse, and they had higher mortality rates and more VTE recurrences. 3 In 2013 Bertoletti et al reviewed 4036 patients with COPD enrolled in Registro Informatizado de la Enfermedad TromboEmbolica registry. 4 The patients presented with symptomatic VTE and were followed for three months.…”

Section: In This Issue Of the Southwest Respiratorymentioning

confidence: 99%

“…3 In 2013 Bertoletti et al reviewed 4036 patients with COPD enrolled in Registro Informatizado de la Enfermedad TromboEmbolica registry. 4 The patients presented with symptomatic VTE and were followed for three months.…”

Section: Editorialmentioning

confidence: 99%

Pulmonary embolus and acute exacerbations of chronic obstructive pulmonary disease

Edriss¹,

Nugent

2014

SW Resp Crit Care Chron

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EditorialIn this issue of The Southwest Respiratory and Critical Care Chronicles, Thompkins and coworkers report a series of four patients with presumed chronic lung disease who presented with acute exacerbations of respiratory symptoms which did not respond to conventional therapy.1 Pulmonary angiography by computed tomography (CTA) eventually demonstrated bilateral pulmonary emboli (PE) in these patients. The authors then discuss the difficulty in making the diagnosis of PE in patients with established chronic lung disease, especially patients who have the diagnosis of COPD. This report raises several important questions, including the frequency of PE in patients with acute exacerbations of COPD, the diagnostic utility of Wells and other criteria in this patient group, the diagnostic utility of D-dimer assays, the best approach to diagnosis in these patients, and the outcomes in these patients.Tillie-Leblond et al investigated the frequency of PE in patients with COPD who were hospitalized with severe exacerbations of unknown origin and did not require invasive mechanical ventilation and investigated the factors associated with PE.2 One hundred and ninety-seven patients with COPD exacerbation were included; all patients had spiral CTAs and 180 had Doppler ultrasound studies of the lower extremities. Forty-three patients had a positive CTA. Six patients had a positive ultrasound study and a negative CTA; 19 of the 43 patients (44%) with confirmed PE by spiral CTA had positive results on the Doppler ultrasound studies. Overall 49 patients (25%) had PE by their criteria which included either a positive CTA or a positive Doppler study and a negative CTA. The risk factors for PE included a previous thromboembolic event, malignant disease, and a decrease in PaCO 2 >5 mmHg from the base line.2 Symptoms and signs, such as pleuritic chest pain, hemoptysis, palpitations, hypoxemia with a PaO 2 <60 mmHg, a PaCO 2 <39 mmHg, and HR >100 beats per minute, did not predict the diagnosis of PE in these patients. The presence of cough was not helpful in supporting the diagnosis of a typical COPD exacerbation.2 Eleven patients with low probability Geneva scores (9% of 119 with low probability in study cohort), 35 patients with intermediate probability scores (47% of 75 with intermediate probability), and three patients with high probability scores (100% of three with high probability) had confirmed PE.Bertoletti and his colleagues prospectively evaluated COPD patients who had venous thromboembolic disease (VTE, i.e., DVT and/or PE) and found that COPD patients presented more frequently with PE (59%) than with DVT (41%).3 Compared to non-COPD patients the three month prognosis in patients with COPD and PE was worse, and they had higher mortality rates and more VTE recurrences. 3 In 2013 Bertoletti et al reviewed 4036 patients with COPD enrolled in Registro Informatizado de la Enfermedad TromboEmbolica registry. 4 The patients presented with symptomatic VTE and were followed for three months. COPD patients with PE had a higher cum...

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Clinical presentation and outcome of venous thromboembolism in COPD

Cited by 94 publications

References 42 publications

COPD and risk of venous thromboembolism and mortality in a general population

COPD and risk of venous thromboembolism and mortality in a general population

Pulmonary Embolism in Patients Hospitalized for Exacerbated COPD and Wheezing

Pulmonary embolus and acute exacerbations of chronic obstructive pulmonary disease

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