Patients with active tuberculosis and high d-dimer levels are at high risk of developing venous thromboembolism, suggests a study published in the Clinical Respiratory Journal.¹

This retrospective study was conducted at a chest hospital in China to assess risk factors for the development of VTE in 11,267 patients who had been diagnosed with TB between January 2016 and January 2020. Patients with active pulmonary and extra-pulmonary TB were selected for the study. Out of the total patients included, 107 patients with TB had VTE. Patients with TB without VTE acted as controls.

The incidence of VTE in patients with TB was 0.95%. Patients with VTE tended to be older with a median age of 65.78 years (vs overall median age of 62.21 years). On univariate analysis, patients with fever, dyspnea, lower limb edema, high prothrombin time, activated partial thromboplastin time and d‐dimer, respiratory failure and malignant tumor were found to be more likely to develop VTE with adverse clinical outcomes. However, hemoglobin levels were considerably lower in the VTE group than in the control group.

Higher D-dimer values, higher incidence of lower limb edema and TB were found to increase the risk for VTE on multivariate analysis. Patients with edema of lower limbs were 5 times more likely to develop VTE with odds ratio of 4.9. Those with high d-dimer levels were at nearly 9 times greater risk of VTE with OR of 8.8, while the presence of active TB increased the risk 16 times with OR of 16.2. However, the use of rifamycin, defined as “inpatient use of at least 3 days before or after hospitalization” was associated with lower risk of VTE (OR 0.170). A d-dimer value of 1855 μg/L was determined as the threshold level with a sensitivity and a specificity of 82.2% and 74.3%, respectively.

This study highlights the higher risk of VTE among patients with active TB compared to the general population. The authors note that the incidence of VTE in their study was “consistent with previously reported studies” and suggest that “physicians should be educated on the prevention and treatment of VTE in TB patients”. Identification of at-risk patients enables timely active intervention to prevent development of VTE. Patients with high d‐dimer level, especially above the cut-off of 1855 μg/L as defined in this study, should 1qparticularly be actively screened and prophylactic anticoagulant therapy may be initiated, if required.

Reference

1. Guo Yi Nan, et al. Risk factors associated with venous thromboembolism in tuberculosis: A case control study. Clin Respir J. 2022 Dec;16(12):835-841. doi: 10.1111/crj.13555.