Does sarcoidosis increase the risk of thrombosis?

Sarcoidosis and Risk of Blood Clots

Yes, sarcoidosis increases the risk of venous thromboembolism (VTE) due to chronic inflammation, hypercoagulability, and potential hematologic abnormalities associated with the disease.

Pathophysiological Mechanisms

Sarcoidosis can increase thrombotic risk through several mechanisms:

1. Chronic Inflammation

   • Systemic inflammation in sarcoidosis promotes a hypercoagulable state 1
   • Inflammatory cytokines can activate the coagulation cascade
   • Bidirectional relationship between inflammation and coagulation processes 1

2. Hematologic Abnormalities

   • Complete blood count abnormalities occur in approximately 22% of patients with sarcoidosis 2
   • Thrombocytopenia may occur through multiple mechanisms:
     • Hypersplenism (most common cause)
     • Bone marrow infiltration by granulomas
     • Immune-mediated thrombocytopenia 3, 4
   • Leukopenia and lymphopenia are common complications related to inflammatory mechanisms 2

3. Cardiac Involvement

   • Cardiac sarcoidosis occurs in 20-50% of patients (often clinically silent) 2, 5
   • Can lead to arrhythmias and reduced cardiac function, increasing thrombotic risk
   • May contribute to thrombus formation due to altered hemodynamics

Clinical Evidence

The association between sarcoidosis and thrombotic events is supported by several case reports and small studies:

• Case reports document concurrent pulmonary embolism and sarcoidosis without other prothrombotic factors 1
• Patients with sarcoidosis and new symptomatology with elevated D-dimers warrant consideration for PE 6
• In some clinical situations, sarcoidosis may be considered a risk factor for deep vein thrombosis/PE 6

Monitoring and Management

For patients with sarcoidosis, especially those with active disease:

1. Risk Assessment

   • Monitor for signs and symptoms of thrombosis, particularly in patients with:
     • Active inflammatory disease
     • Cardiac involvement
     • Hematologic abnormalities
     • Additional risk factors for thrombosis

2. Laboratory Monitoring

   • Baseline complete blood count is recommended to screen for hematologic abnormalities 2
   • Consider D-dimer testing when thrombosis is suspected

3. Management Considerations

   • Standard anticoagulation therapy is indicated when VTE occurs
   • Some case reports suggest that anticoagulant treatment may have additional benefits in sarcoidosis beyond preventing thrombosis 7, 6
   • Potential anti-inflammatory and anti-fibrotic properties of anticoagulation have been reported but require further study 6

Common Pitfalls

• Underdiagnosis: Thrombotic events may be mistaken for worsening sarcoidosis symptoms
• Delayed Diagnosis: New or worsening dyspnea in sarcoidosis patients may be attributed to disease progression rather than PE
• Overlooking Hematologic Manifestations: Hematologic abnormalities in sarcoidosis may be subtle but contribute to thrombotic risk

Conclusion

Patients with sarcoidosis should be considered at increased risk for venous thromboembolism, particularly during periods of active disease. Clinicians should maintain a high index of suspicion for thrombotic events in sarcoidosis patients who present with new or worsening respiratory symptoms, especially when accompanied by elevated inflammatory markers or D-dimers.