Association between features of COPD and risk of venous thromboembolism

Abstract

Introduction Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE) events. A detailed understanding of which clinical features of COPD increase risk of VTE events is needed. Objectives To investigate the association between features of COPD and risk of venous thromboembolism. Methods A retrospective observational clinical study was conducted on 551 consecutive COPD patients visiting the Department of Respiratory and Critical Care Medicine of Tianjin Chest Hospital between February 2014 and April 2018. Finally, 151 patients were eligible for inclusion. Of these, 29 patients had COPD with VTE and 121 patients had COPD without VTE. Patient informations regarding age, gender, BMI, smoking history, smoking status (package/year), COPD‐related symptoms, lung function, number of acute exacerbations and imaging visual emphysema were gathered. Results Among the 29 VTE patients, 18 patients had PE and five had DVT, while 6 patients had simultaneous PE and DVT. There were statistically significant differences in GOLD grade, Imaging visual emphysema, and frequent acute exacerbations between the two groups. Multivariate logistic regression analysis showed that after adjustment for gender, age, BMI and smoking history, there were statistically significant for visible emphysema (OR = 3.54, 95% CI: 1.13‐11.08; P = 0.03) and GOLD grade (OR = 1.77, 95% CI: 1.04‐3.01; P = 0.035), but not for frequent acute exacerbations (OR = 1.65, 95% CI: 0.62‐4.38; P = 0.31). Conclusions Visual emphysema is an independent risk factor for VTE events and the risk of VTE in COPD patients increases with the degree of airway obstruction. However, there is no evidence of an association between exacerbation frequency and VTE events.

Genetic association and causal inference between lung function and venous thromboembolism

“…Such conjectures were verified to some extent in our LDSC results. Several observational studies pointed out that COPD was diagnosed when lung function parameters began to decrease, was characterized by airway limitation and was related to a higher risk of VTE events [ 12 , 50 , 51 ]. Additionally, a prospective population-based study indicated that airway obstruction can increase the risk of VTE events (provoked or unprovoked), and decreased FEV1 and FEV1/FVC, indices of obstructive ventilation dysfunction, were related to a higher risk of VTE events, especially PE [ 11 ].…”

“…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 ].…”

“…Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the ratio of FEV1 to FVC (FEV1/FVC) and peak expiratory flow (PEF) are key indicators for monitoring lung function and can also predict the morbidity and mortality of different respiratory diseases [ 15 – 17 ] as well as all-cause mortality [ 18 ]. A retrospective observational study indicated that the more severe the airway obstruction in COPD patients, the higher the risk of VTE [ 12 ], and another autopsy study noted that patients with emphysema were at higher risk of VTE [ 19 ]. However, no studies have investigated whether different parameters of lung function are causally associated with VTE events.…”

Pulmonary embolism with chronic obstructive pulmonary disease

“…The higher the degree of airway obstruction in COPD patients, the higher the risk of VTE in those patients. 5 Complicated PE is not uncommon in patients with AECOPD. Different studies have shown that the prevalence of PE in patients with AECOPD is very different.…”

“…Venous thromboembolism (VTE) is a type of disease including deep vein thrombosis (DVT) and PTE. The higher the degree of airway obstruction in COPD patients, the higher the risk of VTE in those patients 5 . Complicated PE is not uncommon in patients with AECOPD.…”