Venous Thromboembolic Disease in Chronic Inflammatory Lung Diseases: Knowns and Unknowns

Abstract

Persistent inflammation within the respiratory tract underlies the pathogenesis of numerous chronic pulmonary diseases. There is evidence supporting that chronic lung diseases are associated with a higher risk of venous thromboembolism (VTE). However, the relationship between lung diseases and/or lung function with VTE is unclear. Understanding the role of chronic lung inflammation as a predisposing factor for VTE may help determine the optimal management and aid in the development of future preventative strategies. We aimed to provide an overview of the relationship between the most common chronic inflammatory lung diseases and VTE. Asthma, chronic obstructive pulmonary disease, interstitial lung diseases, or tuberculosis increase the VTE risk, especially pulmonary embolism (PE), compared to the general population. However, high suspicion is needed to diagnose a thrombotic event early as the clinical presentation inevitably overlaps with respiratory disorders. PE risk increases with disease severity and exacerbations. Hence, hospitalized patients should be considered for thromboprophylaxis administration. Conversely, all VTE patients should be asked for lung comorbidities before determining anticoagulant therapy duration, as those patients are at increased risk of recurrent PE episodes rather than DVT. Further research is needed to understand the underlying pathophysiology of in-situ thrombosis in those patients.

An unusual cause of chronic cough

“…Asthma specifi cally has been associated with increased risk of PE at an adjusted odds ratio of 1.4. 8 Percutaneous PFO closure is a treatment option for patients who remain symptomatic or hypoxemic despite optimal medical therapy but has not been shown to improve survival. 6,7 Further treatment was not indicated in the case patient.…”

Prevalence of Hemorrhagic Complications in Hospitalized Patients with Pulmonary Embolism

“…It has been shown that asthma increases the risk for PE. In comparison with the non-asthmatic people, asthmatic patients of all age groups run an increased risk for PE, which is even more increased depending on the age and the severity of the respiratory disease [ 22 ]. Even in a stable phase, COPD is considered an independent risk factor for PE.…”

“…Even in a stable phase, COPD is considered an independent risk factor for PE. At the same time, a meta-analysis suggests that one out of four patients with a COPD exacerbation who need hospitalization may suffer from PE [ 18 , 22 ].…”

Genetic association and causal inference between lung function and venous thromboembolism

“…and some specific genetic conditions (i.e., Factor V, protein C or protein S) account for less than one-fifth of the population attributable risk in the elderly [ 6 , 7 ], but most VTEs are provoked by weak risk factors or even no identifiable risk factors [ 1 , 8 ]. Published evidence indicates that poor lung function is related to increased atherothrombotic risk, with risk factors broadly similar to those for VTE [ 9 , 10 ]. Moreover, chronic lung diseases (e.g., chronic obstructive pulmonary disease (COPD) [ 9 , 11 ], asthma, emphysema, interstitial lung disease [ 12 ]) or postoperative lung cancer [ 13 ], characterized by varying degrees of impairment in different lung function parameters, are related to an increased risk of VTE [ 10 ].…”

“…Published evidence indicates that poor lung function is related to increased atherothrombotic risk, with risk factors broadly similar to those for VTE [ 9 , 10 ]. Moreover, chronic lung diseases (e.g., chronic obstructive pulmonary disease (COPD) [ 9 , 11 ], asthma, emphysema, interstitial lung disease [ 12 ]) or postoperative lung cancer [ 13 ], characterized by varying degrees of impairment in different lung function parameters, are related to an increased risk of VTE [ 10 ]. Another study pointed out that impaired lung function did not affect the VTE risk in cancer patients complicated with PE [ 14 ].…”