title: Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy.
abstract: To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy.
authors.affiliation: Département Thoracique and Département de Réanimation, Institut Mutualiste Montsouris, Paris, France. philippe.girard@imm.fr
authors.forename: P
authors.initials: P
authors.lastname: Girard
authors.forename: M
authors.initials: M
authors.lastname: Decousus
authors.forename: S
authors.initials: S
authors.lastname: Laporte
authors.forename: A
authors.initials: A
authors.lastname: Buchmuller
authors.forename: P
authors.initials: P
authors.lastname: Hervé
authors.forename: C
authors.initials: C
authors.lastname: Lamer
authors.forename: F
authors.initials: F
authors.lastname: Parent
authors.forename: B
authors.initials: B
authors.lastname: Tardy
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D008875:Middle Aged; D010690:Phlebography; D015995:Prevalence; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D011877:Radionuclide Imaging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin