Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India

Abstract

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA). Results were analysed using SPSS version 23. Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

Superior Predictive Value of D-Dimer to the Padua Prediction Score for Venous Thromboembolism in Inpatients with AECOPD: A Multicenter Cohort Study

“…The incidence rate of VTE was 2.01% within 2 months of admission in the inpatients with AECOPD, which was lower than the previous studies, which stated a VTE prevalence of 6.8–16.0%, 6 , 28 , 29 with some studies focused on the prevalence of PE in this population, which was up to 25.8%. 3 …”

“…In this prospective study, only 16.65% (744/4468) inpatients with AECOPD received thromboprophylaxis, which is lower than that reported in medical inpatients in western countries, where more than half of medical inpatients had received thromboprophylaxis during hospitalization. [25][26][27] The incidence rate of VTE was 2.01% within 2 months of admission in the inpatients with AECOPD, which was lower than the previous studies, which stated a VTE prevalence of 6.8-16.0%, 6,28,29 with some studies focused on the prevalence of PE in this population, which was up to 25.8%. 3 The relative low incidence of VTE in this study may attribute to 1) the strictly exclusion of VTE events acquired before hospitalization (a total of 66 patients diagnosed with VTE within 48 h after admission were excluded), 2) that asymptomatic VTE screening was not routinely launched in each inpatient, and 3) that thromboprophylaxis in a small number of patients (16.65%) had an impact on the incidence of VTE.…”

Homoeopathy in Clotting

“…Acute PE presented more than a decade earlier in Indian patients compared with their western counterparts & associated with a very high mortality. Creation of regional centers of excellence serving PE cases with application of PERT concept will lead to improved patient outcomes [6][7][8][9].…”

Acute exacerbation of chronic obstructive pulmonary disease: The clot matters a lot!

“…[ 14 ] This finding is higher than the results from two earlier studies from India, which had estimated the prevalence of VTE in AECOPD to be 9% and 10.3%, respectively. [ 15 16 ] An important take home message from this article is that all AECOPD patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should particularly be screened for PE.…”