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Deep vein thrombosis symptoms and 30-day mortality in acute pulmonary embolism

Published:November 16, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.007

      Highlights

      • Deep vein thrombosis (DVT) is associated with mortality in pulmonary embolism (PE).
      • The impact of DVT symptoms in patients with acute PE and lower-limb DVT is unknown.
      • Patients with DVT symptoms had a higher 30-day all-cause and PE-related mortality.
      • Assessment of DVT symptoms would assist with risk stratification of these patients.
      • Tests to detect lower-limb DVT in PE patients with DVT symptoms would be justified.

      Abstract

      Background

      In patients with acute symptomatic pulmonary embolism (PE), the presence of concomitant lower-limb deep vein thrombosis (DVT) has been associated with a higher mortality rate. The prognostic significance of DVT symptoms among these patients remains uncertain.

      Methods

      We used the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the 30-day mortality rate in patients with PE and concomitant lower-limb DVT, according to the presence or absence of DVT symptoms. Primary outcomes were all-cause death and PE-related death within the first 30 days.

      Results

      Since March 2001 to June 2021, there were 17,742 patients with acute symptomatic PE and objectively proven concomitant lower-limb DVT. Of these, 11,984 (68%) had DVT symptoms. Most patients with or without DVT symptoms (82% vs. 81%) received low-molecular-weight heparin initially. Then, most (61% vs. 58%) switched to vitamin K antagonists. During the first 30 days of therapy, 497 patients with DVT symptoms (4.1%) and 164 (2.8%) with no DVT symptoms died (rate ratio [RR]: 1.48; 95%CI: 1.23-1.77). The rates of PE-related death were: 1.0% vs. 0.7%, respectively (RR: 1.50; 95%CI: 1.04-2.16). On multivariable analysis, patients with DVT symptoms were at increased risk for all-cause death (adjusted hazard ratio [aHR]: 1.49; 95%CI: 1.24-1.78), and PE-related death (aHR: 1.52; 95%CI: 1.05-2.20).

      Conclusion

      Among patients with acute symptomatic PE and concomitant lower-limb DVT, those with DVT symptoms had an increased all-cause and PE-related mortality within 30 days. Assessment of DVT symptoms would assist with risk stratification of these patients.

      Keywords

      Abbreviations:

      aHR (adjusted hazard ratio), CI (confidence interval), CT (computed tomography), CUS (compression ultrasonography), DVT (deep vein thrombosis), PE (pulmonary embolism), RIETE (Registro Informatizado de Enfermedad TromboEmbólica), RR (rate ratio), sPESI (simplified Pulmonary Embolism Severity Index), VTE (venous thromboembolism), V/Q (ventilation-perfusion)
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