Download PDF
Thromb Haemost 2005; 93(03): 494-498
DOI: 10.1160/TH04-09-0587
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients

Nils Kucher
1   Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
Victor F. Tapson
2   Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
,
Samuel Z. Goldhaber
1   Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
,
for the DVT FREE Steering Committee › Author AffiliationsGrant support: This study was funded by an educational grant from Aventis Pharmaceuticals Inc.
Further Information

Publication History

Received 11 September 2004

Accepted after revision 28 February 2004

Publication Date:
14 December 2017 (online)

    Permissions and Reprints

Summary

In patients with deep vein thrombosis (DVT), the factors which predispose to concomitant symptomatic pulmonary embolism (PE) have remained uncertain. From a prospective cohort of 5,451 consecutive patients with ultrasound-confirmed DVT, we analyzed 4,211 patients with a known status for presence (n =639) or absence (n = 3572) of symptomatic PE. Age and gender were similar in DVT plus PE (63.7±15.6 years; 49% men) and DVT patients (63.4±17.3 years; 46% men). Body mass index (BMI) was higher in patients with DVT plus PE (median 29.0, range 15.4–67.0 kg/m2) than in patients with DVT (median 26.8, range 9.7–64.4 kg/m2; p < 0.001). Chronic lung disease (17% vs. 12%; p < 0.001), a personal history of PE (11% vs. 6%; p < 0.001), and a family history of DVT or PE (8% vs. 4%; p < 0.001) were more frequent in DVT plus PE patients. Twenty-seven percent of DVT plus PE patients received prophylaxis prior to the thromboembolic event compared with 32% of DVT patients (p=0.002). Proximal DVT (OR 1.84, 95% CI 1.39–2.43), prior PE (OR 1.68, 95% CI 1.20–2.35), obesity (BMI > 30 kg/m2) (OR 1.65, 95% CI 1.33–2.04), chronic lung disease (OR 1.51, 95%CI 1.13–2.01), as well as omission of prophylaxis (OR 1.30, 95%CI 1.04–1.64) emerged as independent predictors of concomitant symptomatic PE.

Keywords

Deep vein thrombosis - pulmonary embolism - venous thromboembolism
 

  • References

  • 1 Meignan M, Rosso J, Gauthier H. et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med 2000; 160: 159-64.
    CrossrefPubMedGoogle Scholar
  • 2 Moser KM, Fedullo PF, LitteJohn JK. et al. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA 1994; 271: 223-5.
    CrossrefPubMedGoogle Scholar
  • 3 Heit JA, Silverstein MD, Mohr DN. et al. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 1999; 159: 445-53.
    CrossrefPubMedGoogle Scholar
  • 4 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-9.
    CrossrefPubMedGoogle Scholar
  • 5 Eichinger S, Weltermann A, Minar E. et al. Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism. Arch Intern Med 2004; 164: 92-6.
    CrossrefPubMedGoogle Scholar
  • 6 Kniffin Jr. WD, Baron JA, Barrett J. et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154: 861-6.
    CrossrefPubMedGoogle Scholar
  • 7 Murin S, Romano PS, White RH. Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism. Thromb Haemost 2002; 88: 407-14.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Goldhaber SZ, Tapson VF. for the DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-62.
    CrossrefPubMedGoogle Scholar
  • 9 Value of the ventilation/perfusion scan in acute pulmonary embolism Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263: 2753-9.
    CrossrefPubMedGoogle Scholar
  • 10 Remy-Jardin M, Remy J, Deschildre F. et al. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology 1996; 200: 699-706.
    CrossrefPubMedGoogle Scholar
  • 11 Oudkerk M, van Beek EJ, Wielopolski P. et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet 2002; 359: 1643-7.
    CrossrefPubMedGoogle Scholar
  • 12 Stein PD, Athanasoulis C, Alavi A. et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation 1992; 85: 462-8.
    CrossrefPubMedGoogle Scholar
  • 13 Kearon C, Julian JA, Newman TE. et al. Non-invasive diagnosis of deep vein thrombosis. Ann Intern Med 1998; 128: 663-77
    CrossrefPubMedGoogle Scholar
  • 14 Flegal KM, Carroll MD, Ogden CL. et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723-7.
    CrossrefPubMedGoogle Scholar
  • 15 Freedman DS, Khan LK, Serdula MK. et al. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 2002; 288: 1758-61.
    CrossrefPubMedGoogle Scholar
  • 16 Goldhaber SZ, Grodstein F, Stampfer MJ. et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277: 642-5.
    CrossrefPubMedGoogle Scholar
  • 17 Goldhaber SZ, Savage DD, Garrison RJ. et al. Risk factors for pulmonary embolism. The Framingham Study. Am J Med 1983; 74: 1023-8.
    CrossrefPubMedGoogle Scholar
  • 18 Primrose JN, Davies JA, Prentice CR. et al. Reduction in factor VII, fibrinogen and plasminogen activator inhibitor-1 activity after surgical treatment of morbid obesity. Thromb Haemost 1992; 68: 396-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Sundell IB, Nilsson TK, Ranby M. et al. Fibrinolytic variables are related to age, sex, blood pressure, and body build measurements: a cross-sectional study in Norsjo, Sweden. J Clin Epidemiol 1989; 42: 719-23.
    CrossrefPubMedGoogle Scholar
  • 20 Landin K, Stigendal L, Eriksson E. et al. Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1. Metabolism 1990; 39: 1044-8.
    CrossrefPubMedGoogle Scholar
  • 21 Davi G, Guagnano MT, Ciabattoni G. et al. Platelet activation in obese women: role of inflammation and oxidant stress. JAMA 2002; 288: 2008-14.
    CrossrefPubMedGoogle Scholar
  • 22 Russo A, De Luca M, Vigna C. et al. Central pulmonary artery lesions in chronic obstructive pulmonary disease: A transesophageal echocardiography study. Circulation 1999; 100: 1808-15.
    CrossrefPubMedGoogle Scholar
  • 23 Christman BW, McPherson CD, Newman JH. et al. An imbalance between the excretion of thromboxane and prostacyclin metabolites in pulmonary hypertension. N Engl J Med 1992; 327: 70-5.
    CrossrefPubMedGoogle Scholar
  • 24 Alessandri C, Basili S, Violi F. et al. Hypercoagulability state in patients with chronic obstructive pulmonary disease. Chronic Obstructive Bronchitis and Haemostasis Group. Thromb Haemost 1994; 72: 343-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Chaouat A, Weitzenblum E, Higenbottam T. The role of thrombosis in severe pulmonary hypertension. Eur Respir J 1996; 9: 356-63.
    CrossrefPubMedGoogle Scholar
  • 26 Kohn H, Konig B, Mostbeck A. Incidence and clinical feature of pulmonary embolism in patients with deep vein thrombosis: a prospective study. Eur J Nucl Med 1987; 13: S11-5.
    PubMedGoogle Scholar
  • 27 Hull RD, Raskob GE, Coates G. et al. A new noninvasive management strategy for patients with suspected pulmonary embolism. Arch Intern Med 1989; 149: 2549-55.
    CrossrefPubMedGoogle Scholar
  • 28 Huisman MV, Buller HR, ten Cate JW. et al. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 1989; 95: 498-502.
    CrossrefPubMedGoogle Scholar