Chest Infections: Tuberculosis |

VTE in Patients With Mycobacterium TB FREE TO VIEW

Elliot Ho, DO; Rohit Godbole, MD; Caitlin Reed, MD; Nader Kamangar, MD
Author and Funding Information

Olive View Medical Center, Sylmar, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):209A. doi:10.1016/j.chest.2016.08.218
Text Size: A A A
Published online

SESSION TITLE: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Published literature from the 1950s to date suggests an increased prevalence of venous thromboembolism (VTE) in patients with Mycobacterium tuberculosis (TB) infections. Though the exact prevalence is unknown, VTE has been described in 3-4% of patients with TB. Venous thromboembolic disease is potentially life threatening and the morbidity and mortality from VTE in TB patients is unknown. The mechanism of action is presumed to be due to the up-regulation of cytokine production, prothrombotic state of endothelial cells, and venous compression by lymph nodes. We evaluate a specific population of active TB patients at the inpatient TB ward at Olive View - UCLA Medical Center in Los Angeles, California to determine the percentage of TB patients with a concomitant diagnosis of VTE, specifically pulmonary embolism (PE) and deep venous thrombosis (DVT).

METHODS: In this single-centered, retrospective study, we reviewed the charts of patients that were admitted and treated in the inpatient TB ward from August 2011 to February 2016. Patients were selected on the basis of confirmed active TB based on positive acid-fast bacilli (AFB) smears or cultures, radiographic evidence of TB, and/or a high degree of suspicion of active TB prompting anti-TB therapy. In total, 220 patients met these inclusion criteria. Each chart was then reviewed for a prior history of VTE, requirement of anticoagulants for a high suspicion of VTE, and/or the diagnosis of acute VTE with appropriate testing (computed tomography angiography of the chest, ventilation-perfusion scan, and Doppler ultrasound of the extremities).

RESULTS: Of the 220 TB patients, 36 were evaluated with appropriate testing for VTE as mentioned above, out of which 8 (22.2%) had concomitant PE or extremity DVT. Four patients (11.1%) had PE, 3 (8.3%) had extremity DVT, and 1 (2.8%) had both. The diagnosis of VTE was made, on average, 28 days after the diagnosis of TB (range: 8 days before to 112 days after the diagnosis of TB).

CONCLUSIONS: Venous thromboembolism, including DVT and PE, occurs at an annual incidence of about 1 per 1000 adults. In our study, 8 out of 36 (22.2%) patients that underwent appropriate testing were found to have PE and/or DVT. The true prevalence is unknown and may be higher given the lower rate of testing in this study population. Moreover, further underestimation may be possible as some patients were referred from other hospitals and the complete chart, including radiographic studies, could not be reviewed. It is unclear if the concomitant presence of TB and VTE leads to worse outcomes. It is plausible but as yet unproven if active TB is a causative factor in the development of VTE. Further population-wide studies are needed to strengthen the association between TB and VTE and elucidate the underlying pathophysiology.

CLINICAL IMPLICATIONS: Of the active TB patients at the inpatient TB ward who were evaluated for PE or extremity DVT, 22.2% had a concomitant diagnosis of TB and VTE. The study highlights a lower threshold for evaluation of VTE in an active TB patient with concerning signs or symptoms. The association highlights the need for further studies to explore the relationship between TB and VTE.

DISCLOSURE: The following authors have nothing to disclose: Elliot Ho, Rohit Godbole, Caitlin Reed, Nader Kamangar

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543