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Published on: August 26, 2025
Venous thromboembolism with concurrent pulmonary haemorrhage in systemic vasculitis
Erika De Sousa1, Rona Smith, Afzal Chaudhry
1Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge, UK. erikades4@gmail.com
Summary
Systemic vasculitis patients with severe pulmonary hemorrhage (PH) have a 20% rate of concurrent venous thromboembolism (VTE). Anticoagulation is generally effective for VTE but carries a risk of precipitating PH.
Area of Science:
- Rheumatology
- Pulmonology
- Hematology
Background:
- Pulmonary hemorrhage (PH) is a severe, high-mortality complication of systemic vasculitis.
- Systemic vasculitis is also linked to an increased risk of venous thromboembolism (VTE).
- Managing patients with both severe PH and VTE presents significant therapeutic challenges.
Purpose of the Study:
- To review clinical characteristics and treatment responses in vasculitis patients with concurrent PH and VTE.
- To evaluate the safety and efficacy of anticoagulation in this high-risk patient group.
Main Methods:
- Retrospective case review of patients with vasculitis, severe PH, and concurrent VTE.
- Analysis of clinical presentations, vasculitis causes, and VTE management outcomes.
Main Results:
- Seven out of 35 (20%) patients with severe PH due to vasculitis had concurrent VTE.
- Anti-neutrophil cytoplasm antibody-associated vasculitis was the most frequent cause.
- Anticoagulation for VTE was successful in most cases, but one patient experienced PH precipitation, and another developed recurrent VTE without anticoagulation.
- All patients survived the follow-up period without further complications.
Conclusions:
- Concurrent VTE affects approximately one-fifth of severe PH cases in vasculitis.
- Anticoagulation is an effective VTE treatment but requires careful consideration due to the risk of inducing PH.
- Successful management necessitates a balanced approach to anticoagulation in these complex cases.
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