Review article Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD Marco Ambrosetti a, * , Walter Ageno b , Antonio Spanevello c , Mario Salerno a , Roberto F.E. Pedretti a a Division of Cardiology, IRCCS Fondazione Salvatore Maugeri, Institute of Tradate, via Roncaccio 16, 21049 Tradate, Varese, Italy b Department of Medicine, University of Insubria, Varese, Italy c Division of Pneumology, IRCCS Fondazione Salvatore Maugeri, Institute of Cassano delle Murge, Italy Received 9 July 2003; received in revised form 2 December 2003; accepted 3 December 2003 Abstract Background: Little information exists on the prevalence and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients admitted for acute exacerbations of chronic obstructive pulmonary disease (COPD). Objective: To review available literature, we performed a Medline search on papers published on this topic between 1966 and 2003. Data synthesis: Pulmonary emboli have been frequently found (up to 30% of cases) in autoptic series that included patients who died from acute exacerbation of COPD, while the real incidence of PE during exacerbation has never been prospectively evaluated by large-scale clinical studies. Diagnosis of concomitant PE in these patients is often missed because symptoms of acute exacerbation of COPD may mimic PE, and non-invasive evaluation by pulmonary scintigraphy or CT scan is less specific. Even if not fatal, undetected and untreated PE may lead to long-term morbidity from pulmonary hypertension and predispose to recurrent venous thromboembolism (VTE). DVT of the lower extremities affects about 10% of patients with acute exacerbation of COPD at admission, but the rate is likely to be underestimated. The results of clinical trials conducted on general medical patients, including COPD patients, indicate that unfractionated heparin (UH) and low molecular weight heparin (LMWH) significantly reduce VTE rates. However, subgroup data on COPD patients are generally not available. In a single randomised, controlled trial specifically conducted on COPD patients, nadroparin reduced the rate of DVT from 28% to 15% without affecting mortality. Conclusions: Despite a substantial lack of consistent data, VTE appears as a major threat to patients admitted for acute exacerbation of COPD, and pharmacologic prophylaxis should be considered in all high risk situations. However, methodologically rigorous studies in this setting are still needed. D 2004 Elsevier Ltd. All rights reserved. Keywords: Deep vein thrombosis, pulmonary embolism; COPD, prevalence, prevention 1. Introduction Venous thromboembolism (VTE) is a common disorder that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). PE most commonly results from DVT of the lower limbs and represents a major cause of morbidity and mortality. Clinical risk factors for VTE include increasing age, prolonged immobility, previous VTE, cancer, surgery, trauma, estrogen use, and congenital and acquired thrombo- philic disorders. The prevalence of VTE and the efficacy of thromboprophylaxis have been less extensively evaluated in medical patients than in surgical patients: it was calculated that nearly 100,000 patients have been enrolled in trials evaluating VTE in surgery whereas approximately only 15,000 patients were included in trials evaluating medical patients [1]. Among medical conditions, patients with myocardial infarction and ischaemic stroke are those with the highest risk of VTE. The overall incidence of DVT is approximately 24% among patients with myocardial infarction, and increases to more than 50% after ischemic stroke [2]. Patients who are admitted for acute exacerbations of chronic obstructive pulmonary disease (COPD) are gener- ally considered to be at moderate risk for the development of VTE because of the presence of concomitant risk factors such as immobilization, bronchial superinfection, right ven- 0049-3848/$ - see front matter D 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.thromres.2003.12.003 * Corresponding author. Tel.: +39-331-829111; fax: +39-331-829133. E-mail address: mambrosetti@fsm.it (M. Ambrosetti). Thrombosis Research 112 (2003) 203 – 207 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Archivio istituzionale della ricerca - Università dell'Insubria