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

Abstract

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

Incidence of venous thromboembolism in COPD: linking inflammation and thrombosis?

“…Of note, the relatively low overall annual incidence of pulmonary embolism reported in this study is consistent with recent findings indicating a lower venous thromboembolism incidence in Asian countries compared with Western populations [15]. The study by BØRVIK et al [16] is in accordance with these data reporting a higher pulmonary embolism incidence rate in COPD patients (2.7 per 1000 personyears, 41 events in 15 446 person-years) compared with non-COPD patients (1.6 per 1000 person-years, 68 events in 41 744 person-years). Further evidence in line with these observations, although less pronounced, is provided by recent studies demonstrating a higher incidence of pulmonary embolism in patients with asthma: In 31 356 asthma patients from Taiwan's National Health Insurance Research Database, the incidence of pulmonary embolism was higher (0.10 per 1000 person-years) compared with 125 157 individuals without asthma (0.03 per 1000 person-years; HR 3.24, 95% CI 1.74-6.01) [28,29].…”

“…In contrast, data regarding the incidence of venous thromboembolic events in COPD patients during the long-term course are still limited. The present study of Børvik et al [16] adds to this knowledge by demonstrating a higher incidence rate of venous thromboembolism during a long-term observation period in individuals with COPD compared with persons without COPD included in a large population-based study in Norway. Although many systemic inflammatory diseases (such as inflammatory bowel diseases) and acute infections (such as pneumonia and urinary tract infections) have been identified to be associated with a thrombotic tendency and increased risk of venous thromboembolism [20], further studies are warranted to confirm and better understand the impact of systemic inflammation on the development and progression of cardiovascular comorbidities, and venous thromboembolism in particular, in COPD patients.…”

“…In fact, the results of the age-and sex-adjusted Cox-proportional hazard regression models aiming to describe the risk of venous thromboembolism during long-term follow-up in patients with COPD, shown in table 3 of Børvik et al [16], appear to challenge the key message of the study "that patients with severe COPD may have an increased risk of secondary [venous thromboembolism]". After stratifying COPD patients in different stages of disease severity and splitting venous thromboembolism events in the clinical presentation (deep vein thrombosis versus pulmonary embolism) and presence of provoking factors ( provoked versus unprovoked venous thromboembolism), the authors found that COPD stage III/IV was associated with a 2-fold increased risk of secondary venous thromboembolism (defined as provoked or cancer-related venous thromboembolism) compared with subjects with normal spirometry findings (HR 2.05, 95% CI 1.02-4.10) while all other subgroup analyses failed to demonstrate a significant increase in the risk estimates (table 3 of BØRVIK et al [16]). Furthermore, this finding was based on nine patients only (0.1% of the overall patient population) and unsurprisingly loses statistical significance after adjustment for age, sex, current smoking, body mass index and self-reported cardiovascular disease.…”

Correlation between the severity of chronic inflammatory respiratory disorders and the frequency of venous thromboembolism: meta-analysis

“…A total of 8 trials (23,899 patients) were included for analysis (14)(15)(16)(17)(18)(19)(20)(21). Table 1 describes the characteristics of included studies.…”

Chronic Respiratory Abnormalities in the Multi-Morbid Frail Elderly

“…While the risk of thromboembolism and in particular of pulmonary embolism is increased in patients with stable COPD 51 , the size of this risk is variable in stable conditions 52 , but it increases during exacerbations of COPD [53][54][55] (Fig. 6).…”