Infect Chemother.  2019 Jun;51(2):142-149. 10.3947/ic.2019.51.2.142.

Thromboembolism in Mycobacterium tuberculosis Infection: Analysis and Literature Review

Affiliations
  • 1Division of Hematology and Medical Oncology, Department of Internal medicine, Seoul National University Hospital, Seoul, Korea.
  • 2Division of Hematology and Medical Oncology, Department of Internal medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea.
  • 3Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. floresta405@gamil.com
  • 4Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 5Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.

Abstract

BACKGROUND
Tuberculosis is associated with hypercoagulation; however, there are few reports of cases thromboembolism and tuberculosis at the same time in the real world. The purpose of this study was to report the incidence and clinical course of thromboembolism in patients diagnosed with tuberculosis.
MATERIALS AND METHODS
We retrospectively analyzed the data of patients who were diagnosed with both tuberculosis and thromboembolism including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) at Seoul National University Boramae Medical Center from January 2000 through March 2015.
RESULTS
Among the 7905 tuberculosis patients, 49 (0.6%) exhibited PTE, DVT, or both at or after the time of tuberculosis diagnosis. All patients treated for tuberculosis started with isoniazid, ethambutol, rifampicin, and pyrazinamide. Eight patients were switched to treatment with second-line medication because of resistance or adverse events. About half of the patients (n = 21, 44.7%) had thrombosis at the time of tuberculosis diagnosis. Of 48 patients treated for thromboembolism, 36 received warfarin. A total of 20 patients improved symptom caused by thrombosis, and 10 patients were confirmed cure by image study such as computed tomography or doppler ultrasonography. Eight patients who were treated with warfarin had persistent thrombosis. Five patients (10.2%) experienced major bleeding that required hospitalization. All of these bleeding events were associated with warfarin therapy.
CONCLUSIONS
Careful attention to PTE/DVT is needed at the time of diagnosis of tuberculosis and during anti-tuberculosis therapy. Warfarin therapy administered with anti-tuberculosis medication requires frequent monitoring to prevent major bleeding.

Keyword

Tuberculosis; Thromboembolism; Pulmonary embolism; Deep vein thrombosis

MeSH Terms

Diagnosis
Ethambutol
Hemorrhage
Hospitalization
Humans
Incidence
Isoniazid
Mycobacterium tuberculosis*
Mycobacterium*
Pulmonary Embolism
Pyrazinamide
Retrospective Studies
Rifampin
Seoul
Thromboembolism*
Thrombosis
Tuberculosis
Ultrasonography, Doppler
Venous Thrombosis
Warfarin
Ethambutol
Isoniazid
Pyrazinamide
Rifampin
Warfarin
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