Study of Prothrombotic Markers in COPD

  • Mradul Kumar Daga Director Professor, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
  • Naresh Kumar Professor of Medicine & Head, Pulmonary Medicine, Maulana Azad Medical College, New Delhi, India.
  • Govind Mawari Scientist - C, Centre for Occupational and Environmental Health, Maulana Azad Medical College, New Delhi, India.
  • Shashank Singh Senior Resident, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
  • Soumya Jagannath Mahapatra Resident, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
  • Maryam Hussain Department of Medicine, Maulana Azad Medical College, New Delhi, India.
  • Manish K Jha Research Associate, Centre for Occupational and Environmental Health, Maulana Azad Medical College, New Delhi, India.
Keywords: COPD, Prothrombotic Markers, Fibrinogen, Von Willebrand Factor, Acute Exacerbation of COPD


Background: Chronic Obstructive Pulmonary Disease (COPD) is chronic inflammatory condition that is known to be a prothrombotic state. Objective: To study the prothrombotic markers and coagulation profile in patients of Stable COPD and during its exacerbation and to compare these parameters in stable phase of disease and during exacerbation. Materials and Method: A cross sectional study in which 30 patients of COPD with exacerbation and 30 patients with stable COPD were recruited. Patients having acquired thrombotic risk factors like diabetes, hypertension, coronary artery disease, chronic kidney disease, chronic liver disease, malignancy & sepsis or any immunocompromised condition along with those who were on anticoagulant therapy, statins or antihypertensive medications were excluded from the study. Levels of prothrombotic markers (von Willebrand Factor antigen, D-dimer, fibrogen) and Caogulation profile (Prothrombin time and activated Partial Thromboplastin Time) were estimated in both the groups and repeated after stabilization of exacerbation phase also. There parameters were then statistically analyzed. Observation and Results: A generalized prothrombotic state was observed in exacerbation phase of COPD as compared to stable phase of COPD. Furthermore, all the parameters including fibrinogen, vWF, PT and aPTT showed persistent declining trend from exacerbation towards stabilization. Conclusion: COPD with acute exacerbation is a state of augmented prothrombotic state. On stabilization of acute exacerbation with treatment, coagulation profile came to a level lower than that of patients in stable phase of COPD. In exacerbation phase of COPD vWF values were significantly elevated than in stable phase.

How to cite this article:

Daga MK, Kumar N, Singh S, Mawari G, Mahapatra SJ, Jha Mk et al. Study of Prothrombotic Markers in COPD. J Adv Res Med 2020; 7(4): 1-6.



Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001; 163: 1256-76.

Wouters EF. Chronic obstructive pulmonary disease. 5: Systemic effects of COPD. Thorax 2002; 57: 1067-70.

Zureik M, Benetos A, Neukirch C. Reduced pulmonary function is associated with central arterial stiffness in men. Am J Respir Crit Care Med 2001; 164: 2181-5.

Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis. Eur Respir J 2003; 22: 809-14.

Pasceri V, Willerson JT, Yeh ET. Direct proinfl ammatory effect of C-reactive protein on human endothelial cells. Circulation 2000; 102: 2165-8.

Esmon CT. Does inflammation contribute to thrombotic events. Haemostasis 2000; 30(Suppl 2): 34-40.

Ogawa S, Shreeniwas R, Brett J. The effect of hypoxia on capillary endothelial cell function: modulation of barrier and coagulant function. Br J Haematol 1990; 75: 517-24.

Wedzicha JA, Seemungal TA, MacCallum PK. Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL-6 levels. Thromb Haemost 2000; 84: 210-15.

Patrono C, Patrignani P, Rocca B. Characterization of biochemical and functional effects of antiplatelet drugs as a key to their clinical development. Thromb Haemost 1995; 74: 396-400.

Nowak D, Kalucka S, Bialasiewicz P. Exhalation of H2O2 and thiobarbituric acid reactive substances (TBARs) by healthy subjects. Free Radic Biol Med 2001; 30: 178-86.

Szmitko PE, Wang CH, Weisel RD, de Almeida JR, Anderson TJ, Verma S. New markers of inflammation and endothelial cell activation: part I. Circulation 2003; 108: 1917-23.

Fischetti F, Tedesco F. Cross-talk between the complement system and endothelial cells in physiologic conditions and in vascular diseases. Autoimmunity 2006; 39: 417-28.

Wedzicha JA, Syndercombe-Court D, Tan KC. Increased

platelet aggregate formation in patients with chronic airflow obstruction and hypoxaemia. Thorax 1991; 46: 504-7.

Ashitani J, Mukae H, Arimura Y, Matsukura S. Elevated plasma procoagulant and fibrinolytic markers in patients with chronic obstructive pulmonary disease. Intern Med 2002; 41: 181-5.

Mehmet Polatli, Aysel C akir, Orhan Cildag. Microalbuminuria, von Willebrand factor and fibrinogen levels as markers of the severity in COPD exacerbation. J Thromb Thrombolysis 2008; 26: 97-102.

Polosa R, Malebra M, Cacciola RR, Morjaria JB, Maugeri C, Prosperini G. Effect of acute exacerbation on circulating endothelial, clotting and fibrinolytic markers in COPD patients. Internal emergency medicine 2011.

Kannel WB, Wolf PA, Castelli WP. Fibrinogen and risk of cardiovascular disease. JAMA 1987;258: 1183-6.

Bo Zhou, Shufang Liu, Danni He, Kundi Wang, Yunfeng Wamg, Ting Yang et al. Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis. Biosci Rep 2020; 40(7): BSR20193542. DOI: 10.1042/BSR20193542.

Silva DR, Coelho AC, Gazzana MB, Menna Barreto SS, Knorst MM. D-dimer levels in stable COPD patients: a case-control study. COPD 2012; 9(4): 426-31.

Lowe GD, Yarnell JW, Sweetnam PM, Rumley A, Thomas HF, Elwood PC. Fibrin D-dimer, tissue plasminogen activator, plasminogen activator inhibitor, and the risk ofmajor ischaemic heart disease in the Caerphilly Study. Thromb Haemost 1998; 79(1): 129-133.

Rumley A, Lowe GD, Sweetnam PM, Yarnell JW, Ford RP. Factor VIII, von Willebrand factor and the risk of major ischaemic heart disease in the Caerphilly Heart Study. Br J Haematol 1999; 105(1): 110-6.

Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 2003; 124 (2): 459-67.