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Venous thromboembolism in decompensated chronic obstructive pulmonary disease. A prospective study
The American Review of Respiratory Disease
|January 1, 1981
Summary
Pulmonary embolism diagnosis in COPD patients is challenging. Testing lower extremity deep venous thrombosis (DVT) is a potential strategy, but noninvasive tests showed low positive predictive value in this study.
Area of Science:
- Pulmonary Medicine
- Vascular Medicine
- Diagnostic Imaging
Background:
- Pulmonary emboli (PE) are suspected in chronic obstructive pulmonary disease (COPD) respiratory failure.
- Diagnosing PE in COPD patients is difficult due to underlying lung abnormalities.
- Deep venous thrombosis (DVT) in the lower extremities is the presumed origin of most PE.
Purpose of the Study:
- To assess the utility of diagnosing DVT in the lower extremities to reflect PE presence in decompensated COPD patients.
- To evaluate the accuracy of noninvasive DVT tests in this specific patient population.
Main Methods:
- 45 patients with decompensated COPD underwent DVT evaluation.
- Methods included ascending contrast venography, 125I-labeled fibrinogen scanning, Doppler ultrasound, and impedance plethysmography.
- Tests focused on lower extremities to detect deep venous thrombosis.
Main Results:
- Low incidence of DVT observed: 4.4% proximal DVT on admission, 8.9% overall DVT incidence.
- Noninvasive tests (Doppler, IPG) had high negative predictive value (94%).
- Positive results from noninvasive DVT tests had poor predictive value (Doppler 33%, IPG 25%).
Conclusions:
- DVT is infrequent in decompensated COPD patients.
- Noninvasive DVT tests have limited value for diagnosing PE in COPD due to low positive predictive value.
- Further research is needed to improve PE diagnosis in COPD patients.