Egyptian Journal of Chest Disease and Tuberculosis (Apr 2013)
Hypercoagulability in different respiratory diseases
Abstract
Background: The risk of venous thromboembolism (VTE) is equally high in medical patients admitted to the hospital and those treated in the surgery wards. Patients who are immobilized due to heart failure, severe respiratory disease, cerebrovascular stroke and cancer are at a high risk of venous thrombosis. Aim of the work: The aim of the study was to assess the impact of different respiratory insults on blood coagulation for early detection and prevention of thrombosis to open the way for thromboprophylaxis in such cases. Patients and methods: The study included 25 apparently normal healthy control subjects and 141 patients with different respiratory disorders. All patients were subjected to full medical history taking, full clinical examination, and radiological evaluation. Computed tomography (CT) pulmonary angiography was done for all cases and lower limb duplex ultrasonography for all patients, at day 1 and day 5 of admission. The following coagulation markers were evaluated for all patients at day 1, 2,3,4, and 5 of admission including: Soluble fibrin complex, D dimer, thrombin antithrombin complex, antithrombin, protein C, protein S, and fibrinogen. Results: It was found that, the mean values of soluble fibrin complex, D dimer and thrombin antithrombin complex were higher in patients with positive duplex ultrasonograghy and positive CT angiography than patients with negative duplex ultrasonograghy and CT angiography and the difference was statistically highly significant. The higher mean values for soluble fibrin complex was on the third day of admission, while the higher mean values for D dimer, thrombin antithrombin complex and fibrinogen were on the fifth day. Whereas, there are no detectable variations in levels of antithrombin, protein C and protein S on all 5 days there were highly statistically significant differences in soluble fibrin complex, D dimer and fibrinogen levels between all disease groups and the control subjects. The mean values of soluble fibrin complex, D dimer, thrombin antithrombin complex and fibrinogen were higher in severe COPD patients than in moderate COPD patients and the difference was statistically significant while there was no statistically significant difference in coagulation marker levels between moderate and severe asthmatic patients and also, between bronchogenic carcinoma and mesothelioma patients. Conclusions: Estimation of soluble fibrin complex, D dimer, thrombin antithrombin complex and fibrinogen may be useful for early identification of the prethrombotic state which may help to prevent the onset of thrombotic disorders and thereby improve the outcome of various respiratory diseases. Common respiratory disorders especially, COPD exacerbation, pneumonia, interstitial pulmonary fibrosis, and lung cancer are considered to be hypercoagulable states which carry high risks for the development of venous thromboembolism.
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