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General Critical Care

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Should Patients with COPD Exacerbation Undergo Imaging for VTE?

A prospective study conducted in 11 hospitals in China aimed to investigate the prevalence and risk factors for venous thromboembolism (VTE) in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD). The study included nearly 1600 patients who underwent laboratory and imaging screening for VTE, including bilateral lower-extremity ultrasound, computed tomography pulmonary angiography (CTPA), and echocardiogram, and were followed for 1 year. The results showed a VTE prevalence of 25%, with two-thirds of identified VTEs being pulmonary embolisms (PEs), mostly in large vessels. Patients with VTE had significantly higher 1-year mortality compared to those without VTE. The study also identified risk factors associated with VTE, such as cor pulmonale, elevated B-type natriuretic peptide level, or history of VTE, while purulent sputum was associated with a lower risk. Notably, D-dimer elevation was not strongly predictive of VTE. These findings prompt consideration of whether all patients hospitalized with acute COPD exacerbations should undergo imaging for VTE.


Perspective:

While this study contributes significantly to our understanding of VTE in patients with acute COPD exacerbations, further research is warranted to validate these findings and explore whether routine imaging for VTE in all hospitalized patients with acute COPD exacerbations is justified. The potential benefits of early VTE detection and management should be balanced against the costs and resource implications of widespread screening. Collaborative efforts among healthcare professionals, guideline organizations, and researchers are crucial to reach a consensus on the best approach for identifying VTE in this patient population.


The study underscores the high prevalence of VTE in patients with acute exacerbations of COPD and its association with adverse outcomes. The findings raise important considerations regarding the need for routine imaging for VTE in this population. As clinicians, we must remain vigilant about the risk of VTE in these patients and consider individual risk factors when making diagnostic and management decisions. Ultimately, further research and evidence-based guidelines will help guide us in optimizing care for patients with COPD exacerbations and mitigating the impact of VTE on their health outcomes.


Link to the article: Prevalence, risk factor and clinical characteristics of venous thrombus embolism in patients with acute exacerbation of COPD: A prospective multicenter study. Int J Chron Obstruct Pulmon Dis 2023 May; 18:907

Dr.Mohammed ALnadabi
Dr-Yasser Alwali
Alexis Braun
Dr-Yasser Alwali
Jul 29, 2023

Is it reasonable to undergo all chronic obstructive pulmonary disease patients during exacerbation to routine CTPA Because it is expensive and the contrast causes problems

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