Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT

Becattini, Cecilia; Cohen, Alexander T.; Agnelli, Giancarlo; Howard, Luke; Castejón, Borja; Trujillo‐Santos, Javier; Monreal, Manuel; Perrier, Arnaud; Yusen, Roger D.; Jiménez, David

doi:10.1378/chest.15-0808

Cited by 90 publications

(70 citation statements)

References 40 publications

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“…In contrast, Wicki et al [23] have demonstrated that patients with concomitant DVT have higher risk of death compared to patients without DVT. Furthermore, a recent meta-analysis has indicated that the presence of DVT in patients with acute PE is significantly associated with an increased risk of 30-day mortality [24]. In order to evaluate the clinical significance of DVT in patients with PE, we investigated PE-related clinical composite outcomes and 30-day all-cause mortality in this study and compared PE-related outcome and early mortality between non-DVT group and concomitant DVT group.…”

Section: Discussionmentioning

confidence: 99%

Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

Lee

Moon

Kim

et al. 2016

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Purpose:Deep venous thrombosis (DVT) and pulmonary embolism (PE) are considered as similar disease entities representing different clinical manifestations. The objectives of this study were: 1) to determine the prevalence and outcome of DVT in patients with PE; 2) to identify additional risk factors for PE-related unfavorable outcome and 30-day all-cause mortality; and 3) to establish the clinical importance of screening for concomitant DVT.Materials and Methods:From January 2013 to December 2015, a total of 141 patients with confirmed PE were evaluated. The prevalence and outcome of DVT in patients with PE was determined. Furthermore, the potential risk factors for PE-related unfavorable outcome and 30-day all-cause mortality were also analyzed.Results:The prevalence of concomitant DVT was 45.4%. PE-related unfavorable outcome was observed in 21.9% of all concomitant DVT, with all-cause mortality of 21.9%. There was no significant relationship between the presence of concomitant DVT and the development of PE-related unfavorable outcome or all-cause mortality. Our results indicated that heart rate >100/min and peripheral oxygen saturation <90% were independent predictors for PE-related unfavorable outcome. Regarding all-cause mortality, active malignancy and hypotension or shock were significant risk factors.Conclusion:Our findings demonstrate that approximately half of patients with PE possess DVT. However, this study failed to establish any clinical significance of concomitant DVT for PE-related unfavorable outcome and all-cause mortality. Tachycardia and hypoxemia were identified as significant predictors for PE-related unfavorable outcome along with active malignancy and hypotension or shock as significant risk factors of all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

Lee

Moon

Kim

et al. 2016

VSI

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“…This hypothesis, however, should be assessed in prospective clinical trials [44]. By contrast, patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis [40,45]. In addition, long-term Outcomes after PE (ELOPE) Study indicate that almost half of PE patients can be considered to have a "post-PE syndrome" characterized by exercise limitation at 1 year, which influences their quality of life (QOL) and degree of dyspnea [46].…”

Section: Discussionmentioning

confidence: 99%

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

2016

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PurposeWe conducted a cohort study to clarify this relationship between asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and pulmonary embolism (PE).MethodsFrom the National Health Insurance Research Database of Taiwan, we identified patients who had a diagnosis of asthma and a diagnosis of COPD (defined as ACOS) and concurrent treatment between January 1999 and December 2009 (ACOS cohort: n = 14,150; non-ACOS cohort: n = 55,876). Cox proportional hazards regression analysis was performed to determine the adjusted hazard ratios (aHRs) for PE of the ACOS cohort compared with the non-ACOS cohort.ResultsComparing the ACOS cohort with the non-ACOS cohort, the aHR of PE was 2.08 (95% confidence intervals [CIs]: 1.56–2.76). The risk of PE was higher in ACOS cohort than non-ACOS cohort, regardless of age, sex, comorbidity, inhaled corticosteroids (ICSs) and oral steroids (OSs) used. For ages ranging from 20 to 65 years, the aHR of PE was 2.53 (95% CI: 1.44–4.44) in the ACOS cohort. ACOS patients using ICSs (aHR: 1.97, 95% CI: 1.29–3.01) or OSs (aHR: 1.97, 95% CI: 1.46–2.65), the risk of PE was higher than in the non-ACOS cohort. The risk of PE increased with the number of outpatient visits and hospitalizations necessitated, ranging from 2.32 (95% CI: 1.54–3.52) in patients having 3–9 visits to 4.20 (95% CI: 2.74–6.44) for those having >9 visits.ConclusionsACOS is associated with increased risk of PE, particularly patients with a high frequency of AE—even in young adults or people without comorbidities.

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“…The diagnosis of concomitant DVT has been identified as an adverse prognostic factor, being independently associated with death within the first 3 months after acute PE [232]. In a meta-analysis investigating 8859 patients with PE, the presence of concomitant DVT was confirmed as a predictor of 30 day all-cause mortality (OR 1.9, 95% CI 1.5-2.4), although it did not predict PE-related adverse outcomes at 90 days [233]. Thus, concomitant DVT can be regarded as an indicator of significant comorbidity in acute PE.…”

Section: Integration Of Aggravating Conditions and Comorbidity Into Rmentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT

Abstract: word count: 248

Cited by 90 publications

References 40 publications

Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome Associated with Risk of Pulmonary Embolism

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

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