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Prothrombotic state in patients with stable COPD: an observational study
Christos Kyriakopoulos1, Christos Chronis1, Evaggelia Papapetrou2
1Respiratory Medicine Dept, University Hospital of Ioannina, Ioannina, Greece.
Insights
Patients with stable chronic obstructive pulmonary disease (COPD) show a prothrombotic state, with higher coagulation factors and lower inhibitors like protein S and antithrombin. Disease severity correlates with these coagulation changes.
Area of Science:
- Pulmonary Medicine
- Hematology
- Cardiovascular Medicine
Background:
- Chronic obstructive pulmonary disease (COPD) is linked to increased risks of cardiovascular disease and venous thromboembolism.
- Understanding the prothrombotic state in COPD is crucial for managing these comorbidities.
Purpose of the Study:
- To investigate the prothrombotic state in patients with stable COPD.
- To compare coagulation parameters between COPD patients and COPD-free smokers.
Main Methods:
- An observational study comparing coagulation markers in stable COPD patients and control subjects.
- Measured D-dimers, INR, aPTT, coagulation factors (fibrinogen, FII, FV, FVII, FVIII, FIX, FX), and inhibitors (protein S, protein C, antithrombin).
Main Results:
- COPD patients exhibited higher D-dimers, fibrinogen, FII, FV, FVIII, and FX compared to controls.
- COPD patients showed lower levels of protein S and antithrombin.
- More severe COPD was associated with higher FII, FV, FX, and lower protein S levels.
Conclusions:
- Stable COPD patients present a prothrombotic profile with elevated coagulation factors and reduced inhibitors.
- Disease severity in COPD correlates with specific alterations in coagulation factors and protein S levels.
Background:
COPD patients have an increased risk of cardiovascular disease and venous thromboembolism.
Methods:
This study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors; fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors; protein S, proteins C and antithrombin between stable COPD patients and control subjects.
Results:
A total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of D-dimers (median (interquartile range): 360 (230-600) ng·mL-1 versus 240 (180-400) ng·mL-1, p=0.001), fibrinogen (mean±sd: 399±82 mg·dL-1 versus 346±65 mg·dL-1, p<0.001), FII (122±22% versus 109±19%, p=0.004), FV (131±25% versus 121±19%, p=0.015), FVIII (143±32% versus 122±20%, p<0.001) and FX (111 (94-134)% versus 98 (88-107)%, p=0.002), and lower levels of protein S (95 (85-105)% versus 116 (98-121)%, p<0.001) and antithrombin (94.4±11.5% versus 102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher COPD assessment test score had significantly higher levels of FX and lower levels of protein S.
Conclusion:
Patients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease.
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