Significado pronóstico de la trombosis venosa profunda asintomática en pacientes con tromboembolia de pulmón aguda sintomática

Abstract

ObjectiveTo evaluate the prognostic significance of concomitant asymptomatic deep vein thrombosis (DVT) in patients with symptomatic acute pulmonary embolism (PE). MethodsA prospective study was conducted on 820 normotensive patients with PE enrolled in the PROTECT multicentre study. Ultrasound was performed on patients with bilateral lower extremity venous compression to assess for concomitant DVT. The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality, were assessed during the first month of follow-up after PE diagnosis. ResultsOf the 820 patients diagnosed with PE, 46% (375/820) had concomitant DVT, and signs or symptoms of DVT were absent in 51% (193 of 375) of these patients. Overall, 37 out of 820 patients died (4,5%; 95% confidence interval [CI], 3,1%-5,9%). Of the 820 patients, 11 (1,3%; 95% CI, 0,6%-2,1%) died from PE, and 26 (3,2%; 95% CI, 2,0%-4,4%) died from other causes (cancer: 10; congestive heart failure: 4; respiratory failure: 3; major bleeding: 3; miscellaneous diseases: 6). Patients with concomitant asymptomatic DVT had an increased all-cause mortality (odds ratio [OR] 2,77; 95% CI, 1,35-5,67; P=.005) and PE-specific mortality (OR 7,11; 95% CI, 1,42-35,53; P=,02). None of the variables analysed affected the association between DVT and the events studied. ConclusionsIn stable patients with an episode of acute symptomatic PE, the presence of concomitant asymptomatic DVT is an independent predictor of death in the ensuing month after diagnosis.