Prothrombotic state in patients with stable COPD: an observational study

Abstract

BackgroundCOPD patients have an increased risk of cardiovascular disease and venous thromboembolism.MethodsThis study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors: fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors: protein S, proteins C and antithrombin between stable COPD patients and control subjects.ResultsA total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of: D-dimers [360 (230–600) ng·mL−1versus 240 (180–400) ng·mL−1, p=0.001], fibrinogen (399±82 mg·dL−1versus 346±65 mg·dL−1, p<0.001), FII (122±22% versus 109±19%, p=0.004), FV (131±25% versus 121±19%, p=0.015), FVIII (143±32% versus 122±20%, p<0.001), FX [111 (94–134)% versus 98 (88–107)%, p=0.002] and lower levels of: Protein S [95 (85–105)% versus 116 (98–121)%, p<0.001], and antithrombin (94.4±11.5% versus 102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher CAT score had significantly higher levels of FX and lower levels of protein S.ConclusionPatients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease.

Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database

“…The baseline characteristics of this study found that among patients with sepsis, compared with non-COPD patients, patients with COPD were older, had more comorbidities, had a higher SAPSII score, and had a higher proportion of mechanical ventilation support. Moreover, septic patients with COPD had higher NLR, platelet counts, and PTT, lower PO 2 , lower PH, and higher PCO 2 , which were consistent with systemic in ammation [14], prothrombotic state [15,19], chronic hypoxemia [29] and hypercapnia [30] of COPD patients. Taken together, the results reveal that sepsis patients with COPD have poorer conditions when admitted.…”

“…In addition to systemic in ammation, patients with stable COPD have a prothrombotic state. From an observational study, patients with stable COPD showed elevated levels of key coagulation factors (FII, FV, FVIII and FX) and reduced levels of coagulation inhibitors (protein S and antithrombin) [15]. Oxidative stress takes part in the pathogenesis of COPD.…”

“…In another study, COPD patients had higher level of 8isoprostane (a marker of ongoing oxidative stress) in sputum compared with control subject [16]. As dysregulated immune response, coagulation disorders and excessive production of oxidants are speci c characteristics of sepsis [17,18], systemic in ammatory [14], prothrombotic state [15,19]and oxidative stress [20] in COPD patients may promote the development of sepsis. Similarly, the occurrence of sepsis is also one of the causes of acute exacerbation of COPD.…”

Inflammation as the nexus: exploring the link between acute myocardial infarction and chronic obstructive pulmonary disease

“…This increase negatively correlates with pulmonary function and is linked to enhanced IFNγ production in severe COPD, contributing to remodeling responses ( 73 ). Similarly, IL-32 levels correlate positively with COPD severity, suggesting its potential as a biomarker for disease severity ( 74 ).…”

Hypercoagulation in COPD: the clot thickens

“…In this issue of ERJ Open Research , K yriakopoulos et al [ 10 ] add to the current data by presenting an analysis of a set of coagulation factors in a cohort of 103 patients with stable COPD and compare these with 42 control subjects. What makes this analysis compelling is the exclusion of participants with comorbid conditions associated with increased risk of thrombosis and inflammation, including any acute illness, heart failure, coronary artery disease, renal, liver or rheumatic disease, venous thrombosis, malignancy, or use of anticoagulant or antiplatelet drugs.…”