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.
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.
Keywords
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References
- Epidemiology of venous thromboembolism.Nat. Rev. Cardiol. 2015; 12: 464-474
- Acute pulmonary embolism.N. Engl. J. Med. 2010; 363: 266-274
- Risk stratification of normotensive patients with acute symptomatic pulmonary embolIsm.Br. J. Haematol. 2010; 151: 415-424
- Derivation and validation of a prognostic model for pulmonary embolism.Am. J. Respir. Crit. Care Med. 2005; 172: 1041-1046
- RIETE investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.Arch. Intern. Med. 2010; 170: 1383-1389
- Task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) endorsed by the European Respiratory Society (ERS).Eur. Heart J. 2014; 35: 3033-3073
- Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism.Am. J. Respir. Crit. Care Med. 2010; 181: 983-991
- Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: systematic review and meta-analysis.Chest. 2016; 149: 192-200
- On behalf of the PROTECT investigators. Prognostic significance of multidetector computed tomography in normotensive patients with pulmonary embolism: results of the PROTECT study.Thorax. 2014; 69: 109-115
- Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism.Am. J. Cardiol. 2006; 97: 1386-1390
- On behalf of the PROTECT investigators. Prognostic significance of multidetector computed tomography in normotensive patients with pulmonary embolism: rationale, methodology and reproducibility for the PROTECT study.J. Thromb. Thrombolysis. 2012; 34: 187-192
- Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis.Thromb. Haemost. 2003; 89: 228-234
- Prognostic clinical prediction rules to identify a low-risk pulmonary embolism: a systematic review and meta-analysis.J. Thromb. Haemost. 2012; 10: 1276-1290
- The simplified pulmonary embolism severity index (PESI): validation of a clinical prognostic model for pulmonary embolism.J. Thromb. Haemost. 2011; 9: 2115-2117
- A comparison of the original and simplified pulmonary embolism severity index.Thromb. Haemost. 2011; 106: 423-428
- Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model.Eur. Respir. J. 2016; 48: 780-786
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N. Engl. J. Med. 2014; 370: 1402-1411
Article info
Publication history
Published online: February 17, 2018
Accepted:
February 16,
2018
Received in revised form:
February 12,
2018
Received:
December 6,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
