Pneumonia, thrombosis and vascular disease

J Thromb Haemost. 2014 Sep;12(9):1391-400. doi: 10.1111/jth.12646. Epub 2014 Jul 23.


An enhanced risk of cardiovascular mortality has been observed after pneumonia. Epidemiological studies have shown that respiratory tract infections are associated with an increased risk of thrombotic-related vascular disease such as myocardial infarction, ischemic stroke and venous thrombosis. Myocardial infarction and stroke have been detected essentially in the early phase of the disease (i.e. within 48 h from hospital admission), with an incidence ranging from as low as 1% to as high as 11%. Age, previous cardiovascular events and high pneumonia severity index were independent predictors of myocardial infarction; clinical predictors of stroke were not identified. Deep venous thrombosis and pulmonary embolism may also occur after pneumonia but incidence and clinical predictors must be defined. The biological plausibility of such an association may be deduced by experimental and clinical studies, showing that lung infection is complicated by platelet aggregation and clotting system activation, as documented by up-regulation of tissue factor and down-regulation of activated protein C. The effect of antithrombotic drugs has been examined in experimental and clinical studies but results are still inconclusive.

Keywords: blood coagulation; cardiovascular diseases; platelet activation; pneumonia; thrombosis.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Anticoagulants / administration & dosage
  • Blood Coagulation
  • Clinical Trials as Topic
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Myocardial Infarction / complications
  • Myocardial Infarction / epidemiology
  • Patient Admission
  • Platelet Aggregation
  • Pneumonia / complications*
  • Pneumonia / epidemiology
  • Protein C / metabolism
  • Research Design
  • Stroke / complications
  • Stroke / epidemiology
  • Thromboplastin / metabolism
  • Thrombosis / complications*
  • Thrombosis / epidemiology
  • Treatment Outcome
  • Vascular Diseases / complications*
  • Vascular Diseases / epidemiology


  • Anticoagulants
  • Fibrinolytic Agents
  • Protein C
  • Thromboplastin