Venous Thromboembolism in Tuberculosis Patients: A Neglected Co-morbidity

Background: Despite the global efforts to control tuberculosis, it remains a common, life-threatening infectious disease. Tuberculosis can lead to hypercoagulability, increased venous stasis, and endothelial dysfunction, thus increasing the susceptibility to venous thromboembolism (VTE). However, few studies have assessed the epidemiology of the association between tuberculosis and VTE. We recently completed a study to address this coexistence. Methods: Medical records of hospitalized tuberculosis patients at the National Research Institute of Tuberculosis and Lung Disease (NRITLD) from January 2001 to December 2008 were reviewed. Patients with coexisting VTE were selected. Presenting signs and symptoms, and co-morbidities in these patients were studied. Results: 3293 tuberculosis patients were hospitalized, of whom 46 had coexisting symptomatic VTE (31 males, 15 females, mean age: 53.4 ± 19.6 years; DVT: 26, PE: 13, DVT+PE: 7). Of these 46, 29 had a primary diagnosis of tuberculosis, and symptomatic VTE evolved during hospitalization. None of the 29 patients had received VTE thromboprophylaxis. Of the remaining 17 patients with TB and VTE, 15 were tuberculosis patients undergoing outpatient treatment who were admitted to hospital with a primary diagnosis of VTE. Two other patients were initially hospitalized because of VTE, and coexisting tuberculosis was discovered during hospitalization. Mean hospitalization length was 28.6 ± 14.0 days. Four patients died during hospitalization. Median survival time of the patients was 407 days (95% CI: 269.7544.4 days). Conclusion: VTE is an important co-morbidity of tuberculosis patients. Most of our patients developed in-hospital VTE while they were not receiving thromboprophylaxis. Guidelines to institute VTE prophylaxis in TB patients should be considered. Follow-up for VTE signs and symptoms in TB patients is warranted. Tuberculosis (TB) is a serious potentially-treatable infectious disease. Even though the epidemiology and at risk population are not identical in the developed and developing countries, it is a major health problem in both settings. (1) In the early 1940s, it was thought that venous thromboembolism (VTE) is rare in TB patients. (2) However, they are predisposed to venous thromboembolism (VTE) due to several pathophysiologic mechanisms, affecting all three parts of the Virchow’s Triad. Only a few studies have addressed this issue. Therefore, we recently investigated the coexisting venous thromboembolic events among the tuberculosis patients of the National Research Institute of Tuberculosis and Lung Disease (NRITLD), a WHO-collaborating university-affiliated teaching hospital that provides specialized care for TB patients in the Middle East. (6)