Assessment of coexisting deep vein thrombosis for risk stratification of acute pulmonary embolism. Issue 164 (April 2018)

• Record Type: Journal Article
• Authors: Quezada, Carlos Andrés; Bikdeli, Behnood; Barrios, Deisy; Morillo, Raquel; Nieto, Rosa; Chiluiza, Diana; Barbero, Esther; Guerassimova, Ina; García, Aldara; Yusen, Roger D.; Jiménez, David
• Is Part Of: Thrombosis research. Issue 164(2018)
• Page Start: 40
• Page End: 44
• Publication Date: 2018-04
• Subjects: Pulmonary embolism -- Deep vein thrombosis -- Lower limb ultrasound testing -- Prognosis -- Mortality; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2018.02.140
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: In patients with acute pulmonary embolism (PE ), studies have shown an association between coexisting deep vein thrombosis (DVT ) and short-term prognosis. It is not known whether complete compression ultrasound testing (CCUS ) improves the risk stratification of their disease beyond the recommended prognostic models. Methods: We included patients with normotensive acute symptomatic PE and prognosticated them with the European Society of Cardiology (ESC ) risk model for PE. Subsequently, we determined the prognostic significance of coexisting DVT in patients with various ESC risk categories. The primary endpoint was a complicated course after the diagnosis of PE, defined as death from any cause, haemodynamic collapse, or adjudicated recurrent PE. Results: According to the ESC model, 37% of patients were low-risk, 56% were intermediate-low risk, and 6.7% were intermediate-high risk. CCUS demonstrated coexisting DVT in 375 (44%) patients. Among the 313 patients with low-risk PE, coexisting DVT (46%) did not show a significant increased risk of complicated course (2.8%; 95% confidence interval [CI ], 0.8%–7.0%), compared with those without DVT (0.6%; 95% CI, 0%–3.2%), ( P = 0.18). Of the 478 patients with intermediate-low risk PE, a complicated course was 14% and 6.8% for those with and without DVT, respectively ( P = 0.01). Of the 57 patients that had intermediate-high risk PE, a complicated course occurred in 17% and 18% for those with and without DVT, respectively ( P = 1.0). Conclusions: In normotensive patients with PE, testing for coexisting DVT might improve risk stratification of patients at intermediate-low risk for short-term complications. Highlights: In patients with PE, studies have shown an association between coexisting DVT in patients with PE and prognosis. Testing for DVT does not improve risk stratification of low-risk PE patients. Testing for DVT improve risk stratification of intermediate-low risk PE patients.