Wegener’s granulomatosis complicated by pulmonary embolism: a case report and review of the literature

Objectives We investigated the incidence and potential underlying risk factors of venous thromboembolism (VTE) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We assessed haemostatic disturbances and factors that may contribute to the risk of VTE development. Methods ANCA-positive AAV patients (n = 187) were included. Previously identified risk factors for VTE and current medication were retrieved from medical records. We assessed haemostasis using different methods: endogenous thrombin potential (ETP), overall haemostatic potential (OHP), overall coagulation potential (OCP) and overall fibrinolysis potential (OFP) in patients with active AAV (n = 19), inactive AAV (n = 15) and healthy controls (n = 15). Results Twenty-eight VTEs occurred in 24 patients over a total follow-up time of 1020 person-years. A majority of VTEs occurred within the first year after diagnosis. High age (p < 0.01), ongoing prednisolone treatment and recent rituximab administration were more common in the VTE group (p < 0.05 for all). ETP and OHP were significantly increased and OFP significantly decreased in plasma from active compared with inactive AAV-patients (p < 0.05, p < 0.01 and p < 0.05, respectively) and healthy controls (p < 0.001). We could not confirm previously reported risk factors for VTE development. Conclusions A high prevalence of VTE in AAV-patients was seen within the first year after diagnosis, suggesting that disease activity contribute to VTE development. High age and concurrent treatment should also be taken in account when estimating VTE risk. The results also indicate disturbances in the haemostatic balance towards pro-thrombotic condition in AAV patients, where ETP and OHP may be useful markers for identifying patients at high risk.

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Combined diffuse alveolar hemorrhage and venous thrombosis in a patient with granulomatosis with polyangiitis: Case report and systematic review of literature

Tiwari

Madan

Iyer

et al. 2021

Lung India

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Antineutrophil cytoplasmic antibody-associated vasculitis has associations with both thrombosis and diffuse alveolar hemorrhage (DAH). Management of patients having coexistence of both thrombotic and hemorrhagic manifestations is challenging. Thrombotic conditions require anticoagulation, which can theoretically increase the risk of bleeding and thereby worsen DAH. In this review, we highlight the management of a patient of granulomatosis with polyangiitis with DAH who developed deep vein thrombosis. A systematic review of the literature was also performed summarizing and discussing the issues pertaining to the management of such patients.

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Wegener’s granulomatosis complicated by pulmonary embolism: a case report and review of the literature

Cited by 4 publications

References 11 publications

Embolie pulmonaire bilatérale révélant une granulomatose avec polyangéite

Embolie pulmonaire bilatérale révélant une granulomatose avec polyangéite

Venous thromboembolism in anti-neutrophil cytoplasmic antibody-associated vasculitis: an underlying prothrombotic condition?

Combined diffuse alveolar hemorrhage and venous thrombosis in a patient with granulomatosis with polyangiitis: Case report and systematic review of literature

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