Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism.

Details

Serval ID
serval:BIB_92D19EAA9260
Type
Article: article from journal or magazin.
Collection
Publications
Title
Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism.
Journal
American Journal of Respiratory and Critical Care Medicine
Author(s)
Jiménez D., Aujesky D., Díaz G., Monreal M., Otero R., Martí D., Marín E., Aracil E., Sueiro A., Yusen R.D.
Working group(s)
RIETE Investigators
ISSN
1535-4970[electronic], 1073-449X[linking]
Publication state
Published
Issued date
2010
Volume
181
Number
9
Pages
983-991
Language
english
Abstract
RATIONALE: Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance. OBJECTIVES: In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT. METHODS: We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT. MEASUREMENTS AND MAIN RESULTS: The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2% (362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P < 0.001) and PE-specific mortality (adjusted HR, 2.01; 95% CI, 1.18 to 3.44; P = 0.01). CONCLUSIONS: In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.
Keywords
Acute Disease, Aged, Female, Humans, Leg/ultrasonography, Male, Prognosis, Proportional Hazards Models, Prospective Studies, Pulmonary Embolism/complications, Pulmonary Embolism/mortality, Recurrence, Venous Thrombosis/complications, Venous Thrombosis/ultrasonography
Pubmed
Web of science
Create date
18/08/2010 16:31
Last modification date
03/03/2018 19:33
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