Pulmonary embolism and 3-month outcomes in 4036 patients with venous thromboembolism and chronic obstructive pulmonary disease: data from the RIETE registry

Abstract

BackgroundPatients with chronic obstructive pulmonary disease (COPD) have a modified clinical presentation of venous thromboembolism (VTE) but also a worse prognosis than non-COPD patients with VTE. As it may induce therapeutic modifications, we evaluated the influence of the initial VTE presentation on the 3-month outcomes in COPD patients.MethodsCOPD patients included in the on-going world-wide RIETE Registry were studied. The rate of pulmonary embolism (PE), major bleeding and death during the first 3 months in COPD patients were compared according to their initial clinical presentation (acute PE or deep vein thrombosis (DVT)).ResultsOf the 4036 COPD patients included, 2452 (61%; 95% CI: 59.2-62.3) initially presented with PE. PE as the first VTE recurrence occurred in 116 patients, major bleeding in 101 patients and mortality in 443 patients (Fatal PE: first cause of death). Multivariate analysis confirmed that presenting with PE was associated with higher risk of VTE recurrence as PE (OR, 2.04; 95% CI: 1.11-3.72) and higher risk of fatal PE (OR, 7.77; 95% CI: 2.92-15.7).ConclusionsCOPD patients presenting with PE have an increased risk for PE recurrences and fatal PE compared with those presenting with DVT alone. More efficient therapy is needed in this subtype of patients.

Red Cell Distribution Width Has a Predictable Value for Differentiation of Provoked and Unprovoked Venous Thromboembolism

“…In our study, unlike developed countries, the most common risk factors for VTE were acute and chronic medical illnesses including especially activation of chronic obstructive pulmonary disease (COPD), probably due to the fact that our region is a coal mine region and the incidence of COPD in coal mine workers is high because of pneumoconiosis [28]. In another study from RIETE registry, they found that COPD patients presenting with PE have an increased risk for PE recurrence and fatal PE compared with those presenting with DVT alone and more efficient therapy is needed in this subtype of patients [29]. Uhm et al [30] from Korea performed to compare clinical and imaging parameters and prognosis of provoked and unprovoked acute PE patients and they found that provoked PE with irreversible risk factors has a poor prognosis for all-cause mortality and recurrent PE than unprovoked PE and provoked PE with reversible risk factors.…”

Pulmonary embolus and acute exacerbations of chronic obstructive pulmonary disease

“…1 Since patients with COPD have reduced gas exchange and pulmonary vascular reserve, PE may have a worse outcome in these patients, and they have an increased one year mortality rate. 4,5 Some studies suggested that COPD may increase biological thrombotic activities. 6 In addition, during COPD exacerbations patients often have limited mobilization due to dyspnea, and most patients with COPD are either former or current smokers which increases the VTE risk.…”

“…Patients with PE had a slightly higher risk of major bleeding. 4 Gunen studied 131 patients with known and unknown causes of COPD exacerbations and followed them for a year.…”

“…3 In 2013 Bertoletti et al reviewed 4036 patients with COPD enrolled in Registro Informatizado de la Enfermedad TromboEmbolica registry. 4 The patients presented with symptomatic VTE and were followed for three months. COPD patients with PE had a higher cumulative incidence of recurrent VTE as PE, all-cause mortality, and fatal PE than COPD patients presenting with DVT.…”

“…Patients with PE had a slightly higher risk of major bleeding. 4 Gunen studied 131 patients with known and unknown causes of COPD exacerbations and followed them for a year.5 All patients were evaluated with Wells and Geneva criteria and D-dimer assays and underwent CTA to investigate for thrombi in the lower extremities and emboli in the lung and Doppler ultrasound studies of the lower limbs. The frequency of VTE was 16%.…”