Asymptomatic pulmonary embolism in patients with symptomatic deep vein thrombosis of the extremities: Three year results of a prospective study

Abstract

Stavros Kerasidis, George Galyfos, Georgios Kastrisios, Ioannis Stamatatos, Ioannis Stefanidis, Sotirios Giannakakis, Georgios Geropapas, Gerasimos Papacharalampous, Chrisostomos Maltezos

Objective: Symptomatic pulmonary embolism (PE) has been associated with high morbidity and mortality. However, data on the clinical impact of AsPE on patients with known deep vein thrombosis (DVT) are limited in literature. Methods: Patients treated in our institution for symptomatic DVT without any symptoms or signs of PE were prospectively included in this study. The diagnosis of DVT was verified using colored Duplex ultrasonography based on international guidelines. All patients underwent a thorax-computed angiography in order to detect cases with AsPE. Basic characteristics of all patients and major outcomes were compared between patients with DVT and no PE and patients with DVT plus AsPE. Mean follow-up was 3 ± 0.32 years. Results: AsPE was detected overall in 39 patients (32%). The majority (37%) of patients reported long-lasting bed rest/immobility, 15% had a neoplasia, although 32% of patients did not have any typical DVT risk factor. There was no difference regarding age, gender, location of thrombosis or typical risk factors. Basic serum parameters did not differ between the two groups, either. However, more patients with PE showed d-dimer values of <5mg/l compared to patients with DVT only (p=0.017). Deaths from all causes and total days of initial hospitalization did not differ between the two groups. However, AsPE was found to be a risk factor both for new symptomatic PE (RR = 5.675, CI 95% [1.592 – 20.233], p = 0.0074) as well as readmission to hospital (RR = 2.736, CI 95% [1.523 – 4.915], p = 0.0008). Conclusions: AsPE occurs frequently in patients with symptomatic DVT, although neither typical risk factors nor the location of DVT seem to be associated with its presence. Therefore, early recognition of AsPE as well as close long-term monitoring is necessary to reduce possible recurrence and readmission.