Pulmonary Embolism and Deep Venous Thrombosis in Hospitalized Adults with Chronic Obstructive Pulmonary Disease

BACKGROUND: Hospitalized patients with exacerbations of chronic obstructive pulmonary disease (COPD), when routinely evaluated for pulmonary embolism (PE), show PE in 25-29% of cases. We assessed the rate of diagnosis of PE and deep venous thrombosis (DVT) in hospitalized patients with COPD and the influence of age on relative risk compared with hospitalized patients who do not have COPD. METHODS: A retrospective evaluation of data in hospitalized adults with and without COPD from the National Hospital Discharge Survey. RESULTS: From 1979 to 2003, 58,392,000 adults 20 years of age and older, were hospitalized with COPD in the United States. Among these patients, PE was diagnosed in 381,000 (0.65%) and DVT in 632,000 (1.08%). The relative risk of PE in adults hospitalized with COPD was 1.92 and for DVT it was 1.30. Relative risks were age dependent. Among those aged 20-39 years with COPD, the relative risk of PE was 5.34. Among patients aged 40-59 years, the relative risk of PE decreased to 2.02, and among patients aged 60-79 years the relative risk of PE was 1.23. CONCLUSION: These data, when compared with the rate of diagnosis of PE in hospitalized patients with exacerbations of COPD, all of whom were evaluated for PE, indicate that PE in patients with COPD is generally underdiagnosed. In young adults, other risk factors in combination with COPD are uncommon, so the contribution of COPD to the risk of PE becomes more apparent than in older patients.