Risk of recurrent venous thromboembolism in COPD patients: results from a prospective cohort study

Abstract

We aimed to assess the risk of recurrent venous thromboembolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) following cessation of anticoagulation therapy.In a prospective cohort of 1468 patients with a documented episode of VTE, followed for up to 5 years after cessation of anticoagulation therapy, the diagnosis of COPD was confirmed in 136. The main outcome was recurrent VTE. The secondary outcome was overall mortality. Univariate and multivariate analyses were performed to identify the risk factors of recurrence.Of the 1468 patients included, recurrent VTE was observed in 306 (34 with COPD and 272 without) during a median follow-up period of 36.5 months. The incidence rate of recurrent VTE was 9.1% (95% CI 6.5-12.8) for COPD patients and 7.0% (95% CI 6.2-7.9) for non-COPD patients. COPD was not associated with an increased risk of VTE recurrence on univariate or multivariate analyses (hazard ratio: 1.0 (95% CI 0.7-1.4)). The risk of death, adjusted for demographic and clinical characteristics, showed no increase in COPD patients, as compared to non-COPD patients.In patients with COPD who had an acute episode of VTE, the risk of recurrent VTE was not any higher than that in non-COPD patients.

Lack of association between airflow limitation and recurrence of venous thromboembolism among cancer patients with pulmonary embolism

“…Airflow limitation did not increase the risk of VTE recurrence in cancer patients with PE. Taken together with the result from patients without cancer, 15 there seems to be no evidence at present to support different management of PE in patients with COPD. Prospective studies are necessary to confirm whether the coexistence of airflow limitation deserves attention in the management of cancer patients with PE.…”

“…First, because this is a retrospective cohort study in a single referral hospital with a large volume of lung cancer patients, the result of our study may not be generalized to patients in other settings. Second, compared with a recent study of noncancer patients, 15 the follow-up duration was relatively short. This is largely attributable to high number of cancer-related deaths, which also contributed to the limited duration of anticoagulation in our study with a median duration of 4 months.…”

“…A recent prospective cohort study of a large number of patients with long-term follow-up showed that patients with objectively measured COPD did not have an increased risk of VTE recurrence. 15 However, this study did not include active cancer patients, probably to minimize confounding factors.…”

“… 14 Recent data from a prospective cohort study indicated that COPD did not increase the long-term risk of recurrent VTE. 15 Although this study considered major provoking factors such as immobilization after surgery, use of estrogen-containing pills, or hormone replacement therapy, active cancer patients were not included. 15 Cancer is a strong provoking factor of VTE development and outcomes, 4 , 16 – 18 and the prevalence of cancer in COPD patients with PE was as high as 20% in a previous study.…”

“… 15 Although this study considered major provoking factors such as immobilization after surgery, use of estrogen-containing pills, or hormone replacement therapy, active cancer patients were not included. 15 Cancer is a strong provoking factor of VTE development and outcomes, 4 , 16 – 18 and the prevalence of cancer in COPD patients with PE was as high as 20% in a previous study. 14 We therefore investigated the association of spirometry-based airflow limitation with VTE recurrence among cancer patients with PE.…”