Prevalence, Risk Factors of Deep Venous Thrombosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Abstract

Introduction: It is important to increase awareness and identify the predictors of Deep Vein Thrombosis (DVT) in Chronic Obstructive Pulmonary Disease (COPD) patients presenting with worsening dyspnoea, as they are at a high-risk for Venous Thromboembolism (VTE) due to immobility, inflammation, and comorbidities. Aim: To determine the prevalence of DVT in hospitalised patients with acute exacerbation of COPD, as well as to identify associated risk factors for DVT in this group. Materials and Methods: A cross-sectional study was conducted from March 2021 to June 2022 in the Department of Respiratory Medicine at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. The sample population consisted of hospitalised patients with acute exacerbation of COPD who were aged over 40 years. All patients underwent routine blood investigations, Electrocardiograph (ECG), echocardiogram, arterial blood gas analysis, D-dimer test, chest radiograph, and lower-limb venous Doppler. Risk assessment was performed using the Modified Well’s criteria for DVT, and pretest probability was determined for all patients. The Chi-square test was used as a test of significance, with a p-value <0.05 considered statistically significant in all analyses. Results: The mean age of the study population was found to be 60.80±10.21 years. Among the 74 patients included in the study, it was found that 3 (4.05%) patients had DVT. There was no statistically significant difference between the DVT and non DVT groups regarding age, sex, obesity, modified Medical Research Council (mMRC) grade of breathlessness, smoking status, severity of airflow obstruction in spirometry, COPD class, type of respiratory failure, and presence of comorbidities. However, there was a statistically significant difference between the DVT and non DVT groups in terms of elevated D-dimer (>500 ng/mL), history of immobilisation for more than three days, and Modified Wells’ score (>2). Conclusion: Patients with acute exacerbation of COPD, associated with a significant history of immobilisation and high D-dimer values, along with a high-risk pretest probability using clinical predictors such as the Modified Wells’ score for DVT, should be considered for evaluation of VTE and early initiation of prophylactic anticoagulation therapy to prevent Pulmonary Thromboembolism.