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Pulmonary Embolism Among Patients With COPD Exacerbation
Quick Takes
- Acute PE is commonly present in patients with COPD and acutely worsened respiratory symptoms.
- Acute PE is found in >1 in 10 patients with COPD exacerbation if clinically suspected.
Study Questions:
What is the prevalence of pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) who are hospitalized for acutely worsening respiratory symptoms?
Methods:
The authors conducted a multicenter cross-sectional study with prospective follow-up at seven hospitals in France. The authors used a pre-defined diagnostic algorithm for PE, including the Geneva PE risk score, D-dimer levels, computed tomography (CT) scan, and compression ultrasound of the legs within 48 hours of admission. Patients admitted with COPD and acutely worsening respiratory symptoms were enrolled between January 2014 and May 2017. Clinical suspicion of venous thromboembolism was ascertained by a senior clinician before any diagnostic testing was performed.
Results:
Among 740 included patients (mean age 68.2 years, 274 [37.0] women), PE was confirmed within 48 hours of admission in 44 patients (5.9%; 95% confidence interval [CI], 4.5-7.9%). Among the 670 patients without venous thromboembolism on admission who did not receive anticoagulation, PE occurred in five patients (0.7%; 95% CI, 0.3%-1.7%) during follow-up. Death occurred more commonly in patients diagnosed with acute PE as compared to those without (25.9% vs. 5.2%, p < 0.001). Venous thrombosis occurred more commonly in patients with a clinical suspicion for PE than those without the clinical suspicion (11.7% vs. 4.3%).
Conclusions:
The authors concluded that patients with COPD who are hospitalized for acutely worsening respiratory symptoms are diagnosed with acute PE in 5.9% of cases.
Perspective:
Acute PE has long been described as a common cause of COPD exacerbations, estimated in up to 25% of patients. The authors of this study used a pre-defined diagnostic algorithm and high-quality CT scan to assess the prevalence of acute PE in this population. While not as high as prior estimates, >1 in 20 were diagnosed with acute PE. This was even more prevalent if PE was suspected clinically. Routine use of imaging to evaluate for acute PE among patients with COPD who are hospitalized for acutely worsening respiratory symptoms remains a reasonable diagnostic strategy.
Clinical Topics: Anticoagulation Management, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Anticoagulants, Diagnostic Imaging, Pulmonary Disease, Chronic Obstructive, Pulmonary Embolism, Risk Factors, Secondary Prevention, Tomography, Tomography, X-Ray Computed, Ultrasonography, Vascular Diseases, Venous Thromboembolism, Venous Thrombosis
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