Chronic obstructive pulmonary disease and venous thromboembolism recurrents : A prospective study

Abstract

Introduction: Chronic Obstructive Pulmonary disease (COPD) is an inflammatory disease associated with prothrombotic abnomalities. The main objective of the study was to evaluate the risk of recurrent venous thromboembolism (VTE) in patients with a first VTE and COPD. Methods: Of the 1948 patients included, 423 had recurrent VTE (45 patients with COPD and 378 without COPD) during a median follow-up period of 2.4 years. The annual incidence rate of recurrent VTE was 9.2% (95% CI 6.9-12.3) for COPD patients and 5.1 % (95% CI 4.6-5.6) for non COPD patients. COPD was not associated with an increased VTE recurrence risk on multivariate analysis (hazard ratio: 1.2 95% CI 0.9-1.6 p=0.29). In COPD patients, recurrent VTE occurred more often as PE than DVT. The risk of death, adjusted on demographic and clinical characteristics was not increased in COPD patients as compared to non COPD patients. Results: The EDITH study is prospective cohort of 1948 patients with a first VTE recruited between 2001 and 2014. COPD was confirmed by spirometry in 139 patients. The main outcome was documented and adjudicated recurrent VTE after stopping anticoagulation, defined by symptomatic deep vein thrombosis (DVT), non fatal pulmonary embolism (PE) or fatal PE. Secondary outcome was overall mortality. Univariate (using a Log Rank test) and multivariate (using a Cox model) analyses were used to identify risk factors of recurrence. Conclusion: In patients with COPD who had a first episode of VTE, the risks of recurrent VTE and death were not found to be higher than that in non COPD patients. However, recurrences occurred more often as PE rather than DVT in COPD patients.