OC 70.4 - Effect of Steroid Use on Incidence of Pulmonary Embolism in patients with COPD: Korean Nationwide Cohort Study

Background: The differentiation between symptoms of exacerbation of chronic obstructive pulmonary disease (COPD) and pulmonary embolism (PE) is difficult in clinical practice. The steroid use is known to trigger thrombosis, but there is limited information on how the risk of blood clots increases based on the duration and type of steroid use.

Aims: We aimed to assess the effect of duration of steroid use on the occurrence of PE in patients with COPD between 2015 and 2019.

Methods: Primary outcome was defined as PE occurrence with or without deep vein thrombosis.

Results: Among the 246,584 patients in the COPD cohort, 156,445 were classified as steroid users and 90,409 were classified as non-steroid users. VTE occurred frequently in the steroid use group, with a rate of 1.22% (n=1914), compared with 0.97% (n=876) in the non-steroid use group (aHR, 1.22; 95% CI 1.12‒1.31; p< 0.001). The patients who used ICS for more than 365 days exhibited an almost threefold increase in VTE compared to the non-steroid group (aHR 2.90; 95% CI 2.45‒3.42; p < 0.001). Furthermore, compared with the group that only maintained ICS as a reference, the aHR of VTE increased by a 4.5-fold increase (95% CI 3.42‒5.92; p < 0.001) with those for more than 180 days, respectively.

Conclusion(s): The prolonged use of ICS, oral or intravenous steroids in patients experiencing frequent exacerbations of COPD may elevate the risk of VTE. Therefore healthcare providers must keep in mind that VTE could be the potential cause of dyspnea during the next visit for COPD exacerbation.