Skip to main content
SpringerLink
Log in

Clinical Features and Outcomes of Diffuse Alveolar Hemorrhage During Antithrombotic Therapy: A Retrospective Cohort Study

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

Antithrombotic therapy could trigger diffuse alveolar hemorrhage (DAH), and there are several case reports of DAH that occurred during antithrombotic therapy (DAH-AT). However, little is known about the clinical features and outcomes of DAH-AT. The purpose of this study was to clarify the features and mortality of DAH-AT.

Methods

76 consecutive patients with DAH who were admitted to our hospital between January 2003 and April 2014 were retrospectively reviewed to identify the clinical features and outcomes of DAH-AT. The primary outcome was 90-day mortality.

Results

Of the 76 patients with DAH, 39 patients (51 %) had DAH-AT, and 37 patients (49 %) had DAH that occurred with no antithrombotic therapy (DAH-NAT). Of the patients with DAH-AT, 25 (64 %) were taking aspirin, 14 (36 %) were taking warfarin, 5 (13 %) were taking clopidogrel sulfate, and 4 (10 %) were taking cilostazol. Pre-existing cardiac disease was present in 23 (59 %) DAH-AT cases and 5 (14 %) DAH-NAT cases. Logistic regression analysis was used to assess the effect of antithrombotic therapy on the mortality of DAH patients, and no significant difference in survival was seen with antithrombotic therapy (OR 1.18, 95 % CI 0.38–3.78).

Conclusions

Antithrombotic therapies had no effect on the 90-day mortality of DAH patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BAL:

Bronchoalveolar lavage

CI:

Confidence interval

DAH:

Diffuse alveolar hemorrhage

DAH-AT:

Diffuse alveolar hemorrhage that occurred during antithrombotic therapy

DAH-NAT:

Diffuse alveolar hemorrhage that occurred with no antithrombotic therapy

References

  1. de Prost N, Parrot A, Picard C et al (2010) Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality. Eur Respir J 35:1303–1311

    Article  PubMed  Google Scholar 

  2. Antithrombotic Trialists’ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86

    Article  Google Scholar 

  3. Erdogan D, Kocaman O, Oflaz H, Goren T (2004) Alveolar hemorrhage associated with warfarin therapy: a case report and literature review. Int J Cardiovasc Imaging 20:155–159

    Article  PubMed  Google Scholar 

  4. Hayashi S, Maruoka S, Nakagawa Y, Takahashi N, Hashimoto S (2013) Diffuse alveolar hemorrhage associated with low molecular weight heparin. Respirol Case Rep 1:2–4

    PubMed  PubMed Central  Google Scholar 

  5. Boussuges A, Pinet C, Thomas P, Bergmann E, Sainty JM, Vervloet D (1999) Haemoptysis after breath-hold diving. Eur Respir J 13:697–699

    Article  CAS  PubMed  Google Scholar 

  6. Ikeda M, Tanaka H, Sadamatsu K (2011) Diffuse alveolar hemorrhage as a complication of dual antiplatelet therapy for acute coronary syndrome. Cardiovasc Revascularization Med 12:407–411

    Article  Google Scholar 

  7. Kim Y, Lim J, Kim S, Jung T, Choi W (2013) Pulmonary alveolar hemorrhage after clopidogrel use for ST elevation myocardial infarction. Korean Circ J 43:497–499

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kalinczuk L, Lubiszewska B, Demkow M (2011) Normal chest radiograph and ground glass opacities on a thoracic computed tomographic scan in a patient with diffuse alveolar haemorrhage due to dual antiplatelet therapy prescribed after patent foramen ovale percutaneous device closure. Eur Heart J 32:2988

    Article  PubMed  Google Scholar 

  9. Lara AR, Schwarz MI (2010) Diffuse alveolar hemorrhage. Chest 137:1164–1171

    Article  PubMed  Google Scholar 

  10. Fujimoto K, Fujishiro M, Kato M et al (2012) Guideline for the management of antithrombotic agents in the endoscopic procedures. Gastroenterol Endosc 54:2073–2102

    Google Scholar 

  11. Hosmer DW, Lemeshow S (2000) Applied logistic regression. 2nd ed. John Wiley & Sons, New York

    Book  Google Scholar 

  12. Psaty BM, Koepsell TD, Lin D, Weiss NS, Siscovick DS, Rosendaal FR, Pahor M, Furberg CD (1999) Assessment and control for confounding by indication in observational studies. J Am Geriatr Soc 47:749–754

    Article  CAS  PubMed  Google Scholar 

  13. Barnes GD, Lucas E, Alexander GC, Goldberger ZD (2015) National trends in ambulatory oral anticoagulant use. Am J Med. doi:10.1016/j.amjmed.2015.05.044

    PubMed  Google Scholar 

  14. Kirley K, Qato DM, Kornfield R, Stafford RS, Alexander GC (2012) National trends in oral anticoagulant use in the United States, 2007 to 2011. Circ Cardiovasc Qual Outcomes 5:615–621

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Otoshi Takehiro takes responsibility for the content of this manuscript, including the data and analysis. None of the authors declare any conflicts of interest and have financial relationships to disclose. The authors would also like to thank Dr. Kogo and Dr. Teraoka for helping with data collection.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe, Hyogo, 650-0047, Japan

    T. Otoshi, A. Nakagawa, K. Otsuka & K. Tomii

  2. Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan

    Y. Kataoka

Authors
  1. T. Otoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Kataoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Tomii
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Otoshi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otoshi, T., Kataoka, Y., Nakagawa, A. et al. Clinical Features and Outcomes of Diffuse Alveolar Hemorrhage During Antithrombotic Therapy: A Retrospective Cohort Study. Lung 194, 475–481 (2016). https://doi.org/10.1007/s00408-016-9873-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9873-4

Keywords

Search

Navigation