VENOUS THROMBOEMBOLISM IN DECOMPENSATED CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A PROSPECTIVE-STUDY

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Abstract
Largely on the basis of postmortem studies, pulmonary emboli were implicated as an etiologic factor in the acute and chronic respiratory failure of chronic obstructive pulmonary disease (COPD). The diagnosis of pulmonary embolism clinically or by tests directed at the lungs (except pulmonary angiography) is likely to be inaccurate in the presence of COPD because of the underlying abnormalities. Lower extremity tests, to determine the presence or absence of deep venous thrombosis (DVT), might give an accurate reflection of the presence of pulmonary emboli (PE), since virtually all PE apparently arise in those deep veins. In 45 patients with decompensated COPD, ascending contrast venography (12 patients), 125I-labeled fibrogen scanning (6 patients), or both (27 patients) were performed. Only 2 patients had proximal DVT, which was probably present on admission (4.4%). Two other patients developed DVT (limited to the calf) while hospitalized, (overall incidence of 8.9%). Another patient developed superficial thrombophlebitis during the study but before venography. Noninvasive tests for DVT (Doppler ultrasound and impedance plethysmography [IPG]) were performed in 40 subjects. A negative result had a high predictive value (94% for each), but contrary to findings in other settings, a positive test had a poor predictive value (Doppler = 33%, IPG = 25%).