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REVIEW ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 14  |  Page : 1732-1737

Pulmonary Embolism in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease


Department of Respiratory, General Hospital, Tianjin Medical University, Tianjin 300052, China

Correspondence Address:
Dr. Jie Cao
Department of Respiratory, General Hospital, Tianjin Medical University, Tianjin 300052
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.235865

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Objective: In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis. Data Sources: We searched the terms “chronic obstructive pulmonary disease,” “pulmonary embolism,” “exacerbations,” and “thromboembolic” in PubMed database and collected the results up to April 2018. The language was limited to English. Study Selection: We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review. Results: The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation. Conclusions: According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.

 

 Abstract in Chinese

慢性阻塞性肺疾病急性加重合并肺栓塞的研究进展

摘要

目的:大多数国家有接近6%的成年人罹患慢性阻塞性肺疾病(慢阻肺),已成为全球主要的经济和社会负担。有研究表明慢阻肺是肺栓塞的独立危险因素。本综述从多个方面探讨了慢阻肺急性加重合并肺栓塞的发生发展,包括流行病学、病理生理学、危险因素、临床特征、管理及预后。

数据来源:以“慢性阻塞性肺疾病”、“肺栓塞”、“急性加重”和“血栓栓塞”为关键词在Pubmed数据库检索截止到2018年4月相关的英文文献。

研究选择我们仔细审阅了符合检索条件的文献标题和摘要,主要选择前瞻性研究、回顾性研究、荟萃分析及综述加以分析总结。

结果:慢阻肺急性加重合并肺栓塞的发病率因种族、区域、研究设计、样本量的不同而差异较大。总的来说,亚洲人群慢阻肺合并肺栓塞的发病率低于欧美人群,住院患者合并肺栓塞的发病率明显高于急诊留观患者。慢阻肺急性加重的症状往往会掩盖肺栓塞所引起的呼吸困难,因此肺栓塞易被延误诊治,然而慢阻肺急性加重期有诸多危险因素可增加肺栓塞发生风险,有研究发现肥胖和不对称性下肢肿胀是独立的预测因素。因慢阻肺急性加重的住院患者合并肺栓塞的风险较高,所以血栓预防在慢阻肺患者管理中具有至关重要的意义。

结论慢阻肺合并肺栓塞的患者通常会经历较为复杂的临床过程,如死亡风险增加、住院时间延长。所以,对于慢阻肺急性加重的患者(尤其是住院患者),临床医生应严格评估血栓栓塞风险。



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