Should Patients with COPD Exacerbation Undergo Imaging for VTE?

The etiology for acute exacerbation of chronic obstructive pulmonary disease (COPD) is unknown in about one third of patients. Patients with acute exacerbations of COPD are at excess risk for venous thromboembolism (VTE), but screening for VTE in such patients is neither widely done nor guideline recommended. Investigators performed a prospective study of nearly 1600 patients hospitalized for acute exacerbations of COPD at 11 hospitals in China. All patients received laboratory and imaging screening for VTE — including bilateral lower-extremity ultrasound, computed tomography pulmonary angiography (CTPA), and echocardiogram — and were followed for 1 year.

VTE prevalence was 25%. Two thirds of identified VTEs were pulmonary embolisms (PEs), and two thirds of those PEs were in large vessels. Patients with VTE had significantly higher 1-year mortality than patients who didn't have VTE (12.9% vs. 4.5%). One-year mortality was 17% in those with large-vessel PE and 12% in those with small-segmental or subsegmental PE. Patients with purulent sputum had significantly lower risk for VTE (odds ratio, 0.43); whereas patients with cor pulmonale, elevated B-type natriuretic peptide level, or history of VTE had higher risk. D-dimer elevation was not strongly predictive of VTE (OR, 1.1).