Pulmonary embolism: Association between deep vein thrombosis, clinical profile and long-term outcome

Abstract

Although considered as the main cause of pulmonary embolism (PE), deep vein thrombosis (DVT) is not always diagnosed during an episode of pulmonary embolism. In a cohort of patients with acute PE, this study compared baseline clinical data and long-term prognosis according to the presence of concomitant DVT. We conducted a longitudinal, observational, retrospective study in Limoges University Hospital Center. We included patients > 60 years old with a first symptomatic episode of PE who underwent a lower extremities Duplex ultrasonography looking for DVT. The primary combined end-point was mortality and recurrent venous thromboembolic events. A total of 296 patients were included of whom 122 (41%) males with mean age 75.9 ± 7.9 years. The presence of DVT was found in 169 (57%) cases and isolated superficial vein thrombosis in 6 (2%) cases. Compared to those with DVT, patients without DVT had significantly more frequently myocardial infarction within previous 3 months (2.4% vs. 0%, P = 0.045), hip or knee replacement (5.5% vs. 1.2%, P = 0032), and other recent surgery (3.1% vs. 0%, P = 0.020) and less chemotherapy (2.4% vs. 9.5%, P = 0.014). During a mean follow-up of 4.3 ± 3.5 years, 153 (51.7%) deaths occurred and 26 (8.8%) recurrent venous thromboembolic events. Patients with DVT did not have higher mortality or recurrence of venous thromboembolism compared with patients without DVT both at 1- and 8-year (77 ± 3% vs. 82 ± 4%; 37 ± 4% vs. 38 ± 5%, P = 0.244 and P = 0.561, respectively). Patients with DVT had a significantly higher 30-day mortality compared with patients without DVT (91 ± 2% vs. 98 ± 1% P = 0.031). This result remained significant after adjustment for age and predisposing factors of venous thromboembolism responsible of medical and surgical immobilization. Apart from some clinical differences and a worse short term prognosis, concomitant DVT with PE is not associated with increased long-term risk of thromboembolism and mortality.