Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism

David Jiménez, Drahomir Aujesky, Gema Díaz, Manuel Monreal, Remedios Otero, David Martí, Elena Marín, Enrique Aracil, Antonio Sueiro, Roger D. Yusen, Hervè Decousus, Paolo Prandoni, Benjamin Brenner

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123 Scopus citations

Abstract

Rationale: Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance. Objectives: In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT. Methods: We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT. Measurements and Main Results: The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2%(362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P < 0.001) and PE-specific mortality (adjusted HR, 2.01; 95%CI, 1.18 to 3.44; P = 0.01). Conclusions: In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.

Original languageEnglish
Pages (from-to)983-991
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume181
Issue number9
DOIs
StatePublished - May 1 2010

Keywords

  • Deep vein thrombosis
  • Mortality
  • Prognosis
  • Pulmonary embolism
  • Survival

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