Factors Identified as High Risk for VTE in Acute COPD Exacerbation

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.

NEW ORLEANS — Noninvasive ventilation, deep vein puncture/catheterization, bed rest/immobilization, pulmonary heart disease, and type 2 respiratory failure were factors considered to be associated with a higher risk for venous thromboembolism (VTE) in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD), according to data presented at the CHEST Annual Meeting held from October 19 to 23, in New Orleans, Louisiana.

Researchers sought to determine the association of specific factors and predictive biomarkers with high risk for VTE in hospitalized patients with an acute COPD exacerbation. A total of 100 patients (48 in the low-risk group and 52 in the high-risk group) plus 20 controls were enrolled. The researchers divided patients into the high-risk and low-risk groups based on the Padua risk assessment score, and the high-risk group was further subdivided into the anticoagulation group and non-anticoagulation group, depending on the use of low molecular weight heparin (LMWH).

Plasma levels of new coagulation-fibrinolytic biomarkers such as thrombomodulin, thrombin-antithrombin complex, plasminogen-α2 plasminogen inhibitor complex, and tissue-type plasminogen activator-plasminogen activator inhibitor complex, as well as route coagulation-fibrinolysis parameters were measured on the day of admission, the third day, and the seventh day after admission.

Among the high-risk group patients, noninvasive ventilation treatment, deep vein puncture/catheterization, bed rest/immobilization for >3 days, pulmonary heart disease, and type 2 respiratory failure were more common. The duration of hospitalization was also significantly longer in the high-risk vs low-risk group (P <.05). Patients with an acute exacerbation of COPD had higher levels of the new coagulation-fibrinolytic biomarkers, higher levels of white blood cells and neutrophils, longer plasma prothrombin time and activated partial thromboplastin time, and higher fibrinogen concentration, D-dimer, and fibrinogen degradation product on the day of admission compared with controls (P <.05).

“The dysfunction of the blood coagulation-fibrinolysis system is a salient characteristic of VTE requiring optimized management depending on its severity,” the researchers wrote.

Partial pressure of carbon dioxide, neutrophil count, and thromboplastin time level may serve as predictors of higher risk for VTE and could guide treatment strategies with LMWH to prevent VTE.

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Reference

Guo L, Liu J, Zhao T, et al. Association of impact factors and predictive biomarkers with high risk of venous thromboembolism in hospitalized patients with acute exacerbation of COPD. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1111.