COPD and Anticoagulation Therapy: Time for a New Approach?

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the most challenging chronic disease nowadays due to increased morbidity and mortality, despite the multiple new therapies included in the therapeutic scheme. A possible cause may be insufficient approach to thromboembolic risk in these patients, scientific data being so far insufficient and relatively controversial. Areas covered: anticoagulant therapy is used mainly during severe exacerbations. There are data that have shown that therapy with low weight heparins injectable anticoagulants causes not only a reduction in thromboembolic risk but also an improvement in respiratory function parameters. Expert opinion: a number of COPD phenotypes are more prone to procoagulant status and thrombus formation. A layered approach to COPD patients in terms of antithrombotic prophylaxis is needed. Although current published clinical data have not provided irrefutable evidence, possibly due to the relatively heterogeneous approach to inclusion criteria, the frequent identification of autopsy holes in patients with COPD suggests that the high risk of mortality is due to specific bronchopulmonary changes and pulmonary embolism.

Effects of oral anticoagulant therapy in patients with pulmonary diseases

“…These cytokines inhibit plasminogen activators. The procoagulant effect is initiated by tissue factor, IL-6, and the tumor necrosis factor ( 17 ). All of the above cytokines contribute to the amplification of procoagulant processes, therefore, COPD could induce the occurrence of venous thromboembolism and pulmonary embolism.…”

“…Chronic obstructive pulmonary disease is associated with neutrophilic inflammation and T-lymphocytes activation ( 17 ). In recent years, macrophages have also been confirmed to be involved in COPD: the inhaled particles activate alveolar macrophages, which then release cytokines and chemokines, including interleukins (IL)-1α, IL-1β, IL-33, and IL-18 ( 50 ).…”

“…In addition, COPD as one of the most challenging chronic diseases, is closely related to inflammation. Venous thromboembolism (VTE) is a common and potentially fatal complication of COPD, whose morbidity could be significantly increased by COPD (odds ratio between 2 and 9) ( 16 , 17 ). Moreover, PE is also common comorbidity of COPD ( 18 – 20 ), which might induce disease deterioration.…”

Efficacy and safety of inhaled heparin in asthmatic and chronic obstructive pulmonary disease patients: a systematic review and a meta-analysis

“…asthma, COVID-19, etc.). In addition to Petris’ review 69 found that anticoagulation therapy is very important for COPD patients and can reduce their risk of mortality due to some bronchopulmonary changes and pulmonary embolism. Also, it was noted that the antioxidant properties of heparin can contribute to decreased inflammation and safeguard anti-proteins against oxidative inactivation, limit reactive oxygen species (ROS)-induced mucus hypersecretion, and counteract the oxidative stress as a feature of bronchial asthma and COPD, with their wide-ranging effects in the airways and lung parenchyma specifically in COPD patients 13 .…”