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Pneumonia, thrombosis and vascular disease.
J Thromb Haemost. 2014 Jun 23;
Authors: Violi F, Cangemi R, Calvieri C
Abstract
An enhanced risk of cardiovascular mortality has been observed after pneumonia. Epidemiological studies have shown that respiratory tract infections are associated with an increased risk of thrombotic-related vascular disease such as myocardial infarction, ischemic stroke and venous thrombosis. Myocardial infarction and stroke have been detected essentially in the early phase of the disease, i.e. within 48 hours from hospital admission, with an incidence ranging from as low as 1% to as high as 11%. Age, previous cardiovascular events and high pneumonia severity index were independent predictors of myocardial infarction; clinical predictors of stroke were not identified. Deep venous thrombosis and pulmonary embolism may also occur after pneumonia but incidence and clinical predictors must be defined. Biological plausibility of such association may be deduced by experimental and clinical studies, showing that lung infection is complicated by platelet aggregation and clotting system activation, as documented by up-regulation of Tissue Factor and down-regulation of activated Protein C. The effect of antithrombotic drugs have been examined in experimental and clinical studies but results are still inconclusive. Thrombotic-related vascular disease such as myocardial infarction, stroke and venous thrombosis may complicate the clinical course of pneumonia and worsen its prognosis. Further definition of predictors may help to identify patients at higher risk of artery and venous thrombosis. Patients with pneumonia could benefit from antithrombotic strategy including anticoagulants and/or antiplatelet drugs but this should be tested in randomized clinical studies. This article is protected by copyright. All rights reserved.
PMID: 24954194 [PubMed - as supplied by publisher]