Patients with isolated pulmonary embolism in comparison to those with deep venous thrombosis. Differences in characteristics and clinical evolution

Abstract

Background: Patients with acute pulmonary embolism (PE) often have leg deep vein thrombosis (DVT); sometimes, however, a DVT is not detected (isolated PE, I-PE). We aimed at assessing the proportion of patients with I-PE, and their characteristics and clinical evolution compared to those with DVT with/without PE (DVT/PE). Methods: Among 3573 patients included in the START2-Register for a venous thromboembolic event, 2880 (80.6%) had DVT/PE, the remaining I-PE (19.4%). Results: Patients with I-PE were older [(≥75 years, OR 1.4 (95%CI 1.13-1.69)], and more frequently females ]. Young females (aged ≤ 50 years) with an index event occurring during hormonal contraception (HC), were more prevalent in I-PE ]. At multivariate analysis, age > 75 years, female sex, heart failure, cancer and use of HC were risk factors significantly associated with I-PE, whereas thrombophilic alterations were associated with DVT/PE. During a follow-up of 4504 years (during anticoagulation), the rate of bleeding events was 1.1% patient/years and 1.0% patient/years in I-PE and DVT/PE, respectively. Venous thromboembolic events were equally prevalent in DVT/PE or I-PE (1.94% vs 0.86%, ns), whereas arterial complications were more prevalent in the latter group (1.01% vs 0.28%, p = 0.008). Conclusion: I-PE and DVT/PE have important differences. Older age, female sex, heart failure and cancer, were risk factors for I-PE; thrombophilic alterations were associated with DVT/PE. HC use was more frequent in the I-PE group. The prevalence of arterial complications was higher in patients with I-PE. Further studies, specifically designed on this issue, are warranted.Survival after 3 months from the event has been reported as low as 62.8% in case of PE, a rate much lower than that after DVT alone (91.9%) [5]. The 30-day case-fatality rate is higher in patients with PE than in those with DVT (9.7% vs. 4.6%, respectively [4]), with a risk of dying that is higher in the first months from the event, to gradually lower subsequently.In the majority of cases, PE occurs as a complication of a clinically

Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified?

“… 5 The discrepancy between the frequencies of pulmonary embolism and DVT is surprising, because, although pulmonary embolism may occur in the absence of detectable DVT, this happens in only approximately 20% of studied patients. 10 Therefore, we question whether the observed pulmonary vessels occlusions that have been described in reports on COVID-19 patients are exclusively caused by pulmonary embolism. In our experience and in some reports, 11 12 filling defects of pulmonary vessels that are detected by CTA scans are in many instances more reminiscent of pulmonary thrombi rather than emboli, because they are not fully occlusive.…”

Lessons from tofacitinib in patients with cardiovascular risk factors: increased pulmonary embolism or isolated (thrombotic) pulmonary occlusion rates?

“…PE in the absence of a DVT (isolated pulmonary embolism (i-PE)) became the focus of recent research which identified a distinct clinical and risk profile for i-PE among 3573 patients of the START2 registry. 6 Importantly, 20% fulfilled the criteria of i-PE without DVTs in the general population. Multivariate analysis revealed that older age (>75 years), female sex, heart failure or cancer, and the absence of thrombophilic alterations are risk factors.…”

A New Way of Looking at an Old Problem

“…The findings of the study are consistent with registry data, suggesting an increased incidence of arterial events among those with isolated PE. 3 Further analysis of registry and additional prospective study would be useful to confirm the relationship between isolated PE and arterial thrombotic events.…”

“…However, in a substantial portion of patients with PE, there is no DVT evident at the time of diagnosis. [1][2][3] This increasingly recognized clinical entity has been termed isolated PE. Isolated PEs are frequently small, nonocclusive thrombi located in segmental or subsegmental pulmonary arteries and may be discovered incidentally.…”

“…In fact, these preliminary data suggest despite a similar or reduced risk of recurrent VTE, patients with isolated PE have a higher risk of death, which appears to be largely driven by cardiovascular comorbidities. 3,9 Perhaps the optimal treatment strategy will incorporate aggressive risk factor modification for cardiovascular disease. Further study is required to determine if the antiinflammatory effects of statins might reduce the risk for recurrent thrombosis by decreasing inflammation.…”