Patients with COPD exacerbations at high risk for VTE
MedWire News: Chronic obstructive pulmonary disease (COPD) patients who have been hospitalized for an exacerbation are at high risk for venous thromboembolism (VTE), results from a Turkish study show.
The researchers recommend that all COPD patients hospitalized for an exacerbation should be evaluated for thromboembolic events unless D-dimer levels and Wells criteria indicate otherwise.
H Gunen (Inonu University, Malatya) and team studied data on 131 consecutive patients (20.6% female), aged an average of 67 years, who were admitted to Inonu University hospital for a COPD exacerbation.
All the patients underwent detailed clinical evaluation at admission, and computed tomographic angiography and ultrasonographic examination were used to assess for the presence of deep vein thrombosis (DVT) and pulmonary embolism (PE).
Overall, DVT and/or PE was detected in 21 (16%) patients – DVT in 14 and PE in 18 patients.
The researchers found that the prevalence of VTE was three times higher in patients with exacerbations of unknown origin (n=60) than in those with exacerbations of known origin (n=71).
There was no significant difference in VTE prevalence according to COPD severity.
The mean D-dimer level was significantly higher in patients with VTE than in those without VTE, at 5.2 versus 1.2 µg/ml. Indeed, all but one patient with VTE had elevated D-dimer levels (>0.5 µg/ml). The negative predictive value of D-dimer testing for VTE was 0.98.
For predicting PE, both the sensitivity and positive predictive value of the Wells criteria for moderate- and high-probability cases were significantly higher than those of the Geneva criteria, the researchers note in the European Respiratory Journal.
They also found that mortality at the 1-year follow-up was significantly higher in patients with VTE than in those without, at 61.9% versus 31.8%.
Gunen and team conclude: “VTE is a common problem in COPD patients hospitalized with an exacerbation, leading to high long-term mortality.
“D-dimer levels and the Wells criteria can be used to determine whether or not these patients are assessed for a thromboembolic event.”
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By Mark Cowen