PURPOSE: Chronic obstructive pulmonary disease (COPD) is a known but poorly characterized risk factor for acute deep vein thrombosis (DVT). We sought to characterize the clinical manifestations of patients of acute DVT in patients with COPD.
METHODS: We compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 668 (12%) patients with COPD to 3,907 patients without COPD. We utilized a prospective registry of 5,451 consecutive patients with ultrasound-confirmed DVT at 183 institutions in the United States.
RESULTS: COPD patients with acute DVT were older (median 72.5 years versus 68.0 years, p < 0.0001) and more likely to be male (52.3% versus 44.8%, p = 0.0004). They were more likely to be inpatients at the time of diagnosis of DVT (62.0% versus 51.9%, p < 0.0001). COPD patients were more likely to be admitted to the Intensive Care Unit (ICU) (27.7% versus 19.8%, p = 0.0003), more likely to require mechanical ventilation (23.2% versus 13.6%, p < 0.0001), and more likely to receive inferior vena caval (IVC) filters (19.1% versus 15.1%, p = 0.009). COPD patients more often had concomitant pulmonary embolism (PE) (22.8% versus 17.8%, p = 0.005) as well as concomitant congestive heart failure (29.5% versus 12.5%, p < 0.0001).
CONCLUSION: Acute DVT patients with COPD have a greater medical acuity than other DVT patients. COPD in DVT patients defines a cohort requiring more hospital resources including the use of ICU beds and insertion of IVC filters. These patients more often have concomitant PE, leading to the development of cor pulmonale. Future studies should target the management of patients with COPD because DVT and COPD constitute a high-risk combination.
CLINICAL IMPLICATIONS: COPD patients with DVT constitute a high-risk group, more likely to suffer concomitant PE. This study should increase the awareness of the possibility of DVT and PE in patients with COPD and promote further investigation into the role that PE may play in the development of cor pulmonale in patients with COPD.
DISCLOSURE: Ranjith Shetty, No Financial Disclosure Information; No Product/Research Disclosure Information