PE presents ‘therapeutic challenge’ in COPD
medwireNews: Researchers have found that those patients who develop pulmonary embolism (PE) have the poorest outcomes among chronic obstructive pulmonary disease (COPD) patients with venous thromboembolism (VTE).
Laurent Bertoletti (University Saint-Etienne, France) and colleagues analyzed data from 4036 COPD patients who represented 10.9% of all VTE patients enrolled into the international RIETE study between 2001 and 2011.
In agreement with previous studies, they found a preponderance of PE over deep vein thrombosis (DVT) among COPD VTE patients, being diagnosed in 2452 (61%) patients.
Over 3 months’ follow up, COPD patients with PE were two-fold more likely to experience a recurrence as PE, and nearly seven-fold more likely to die from PE, than those with DVT (4.1 vs 1.1% and 3.1 vs 0.4%, respectively). Additionally, cancer, which was reported among 22% of COPD patients, was an independent risk factor for fatal PE, as was recent immobilization.
The authors also detected a trend for an increased risk for major bleeding in patients with PE, which was reported in 3.0% of PE patients and 2.0% of DVT patients over 3 months.
And, 12.5% of PE patients died from any cause during follow up, significantly more than the 8.7% of DVT patients who died.
Noting that patients presenting with PE were more likely to die from fatal recurrent PE than fatal bleeding, the authors say that “these observations suggest that in COPD initially presenting with PE the major concern should be recurrent (and potentially fatal) PE.”
Bertoletti and team write in Respiratory Research: “As PE is the main cause of death during the 3-month follow-up, there is a huge need for treatment which would be more efficient in terms of PE occurrence but also which would not induce an increase in the bleeding risk.”
“In this view, retrievable vena cava filter, which protect the pulmonary vascular bed without increasing the bleeding risk, deserves further evaluations,” they conclude.
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By Kirsty Oswald, medwireNews Reporter