Warn that anticoagulants must be systematically administered to patients with exacerbated COPD

Patients hospitalized for crises or exacerbations of symptoms caused by chronic obstructive pulmonary disease (COPD) must receive systematic prophylactic anticoagulant treatment. This is due to the fact that they present a high risk of cardiovascular problems, having an increase in factors that favor blood clotting, as revealed by a study from the Pneumology Service of Hospital del Mar and the research institute of the center, which analyzed the protein profiles in their blood. The work is published in the journal ERJ Open Research.

Researchers analyzed blood samples from 70 individuals. 20 were healthy, non-COPD individuals, while the rest were patients with this disease in various states. Some were stable, not needing hospitalization. Others were considered stable but had to be hospitalized three or more times a year due to crises caused by the disease. The rest were patients hospitalized for an exacerbation. Proteomic tools were used to profile the proteins present in their blood for comparison, identifying more than 300 proteins and peptides in the samples.

It was thus verified that COPD patients who need to be hospitalized relatively frequently, despite being considered stable, have a blood protein profile very similar to those hospitalized for a crisis. "This indicates that these patients are in a nearly continuous state of exacerbation, despite being clinically stable," points out Dr. Joaquim Gea, emeritus head of the Pneumology Service and researcher at the research institute of Hospital del Mar. In both cases, their blood showed proteins related to inflammation and the immune system, indicating systemic inflammation and a defective immune response in the patients.

This fact leads the authors to recommend changing the monitoring of this group of patients, making it more thorough.

Prothrombotic State During a Crisis

The blood protein profile of patients with COPD changes when they suffer an exacerbation of the disease. At this time, there is an increase in proteins that favor coagulation, a prothrombotic state, indicating they are at high risk of cardiovascular complications or death for this reason. A problem that is exacerbated because these people have reduced mobility during their hospital stay.

"In these cases, many of the exacerbations could be more a cardiovascular problem than fundamentally a respiratory one, and we do not detect this in regular practice", explains Dr. Gea. For this reason, "heparin prophylaxis should always be performed to prevent thrombus formation, and monitoring should not only be respiratory but should also take into account this cardiovascular risk", he adds. At this time, this recommendation is not routinely followed in all patients hospitalized for COPD exacerbation.

This study is the first to use two complementary analytical techniques to study the blood protein profile in this type of patients. Researchers from CIBER of Respiratory Diseases (CIBERES), as well as hospitals Hospital Clínic de Barcelona, Hospital 12 de Octubre, and Fundación Jiménez Díaz de Madrid, Clínica Universitaria de Navarra, Hospital Universitario Virgen del Rocío de Sevilla, Consorci Sanitari Parc Taulí de Sabadell, and Hospital Sos Espases de Palma de Mallorca also participated.

Image: From left to right, Sergi Pascual, Joaquim Gea, Carme Casadevall and Oswaldo Antonio Caguana

Reference Article: Cesar Jesse Enríquez-Rodríguez, Carme Casadevall, Rosa Faner, Ady Castro-Costa, Sergi Pascual-Guàrdia, Luis Seijó, José Luis López-Campos, Germán Peces-Barba, Eduard Monsó, Esther Barreiro, Borja G. Cosío, Alvar Agustí, Joaquim Gea

ERJ Open Research Jan 2024, 00004-2024; DOI: 10.1183/23120541.00004-2024