Deep venous thrombosis in patients with acute pulmonary embolism: prevalence, risk factors, and clinical significance.
OBJECTIVE
To determine the prevalence of lower-limb deep venous thrombosis (DVT) that can be detected by compression ultrasonography (CUS) in patients with symptomatic pulmonary embolism (PE) diagnosed with spiral CT pulmonary angiography (CTPA); and to explore the risk factors for positive CUS results and the prognostic significance of such findings.


METHODS
Post hoc analysis of data from a prospective multicenter outcome study of 1,041 patients with clinically suspected non-severe PE. All patients underwent CTPA and CUS within 24 h of enrollment and were followed up for 3 months.


METHODS
Among the 290 patients with positive CT findings, CUS was diagnostic in 281 patients who constitute the study population.


RESULTS
Mean age +/- SD was 64.3 +/- 17.7 years; 128 patients (44.8%) were men. DVT signs or symptoms were present in 90 patients (32%). CUS detected DVT in 169 patients (60.1%; 95% confidence interval [CI], 54.1 to 65.9%), including 127 patients (45.2%; 95% CI, 39.3 to 51.2%) with proximal DVT. Sensitivity and specificity of DVT symptoms for CUS-detectable DVT were 43% and 85%, respectively. Multivariate analysis showed that an age > or = 70 years (odds ratio [OR], 1.90; 95% CI, 1.14 to 3.17) and the presence of DVT signs or symptoms (OR, 4.12; 95% CI, 2.24 to 7.55) were independent risk factors for positive CUS results. DVT symptoms (OR, 4.78; 95% CI, 2.75 to 8.33) and a history of venous thromboembolism (OR, 2.59; 95% CI, 1.46 to 4.62) were independent risk factors for proximal DVT. The 3-month risk of recurrent thromboembolic event or death was not significantly different among patients with and without DVT (6.5% vs 2.7%, p = 0.15).


CONCLUSIONS
These results do not support screening for DVT in patients with CTPA-proven symptomatic PE; however, they suggest that CUS might prove especially efficient and safe as a frontline test in elderly patients with suspected PE. Further studies are needed before these conclusions can be translated into clinical recommendations.
Girard
Philippe
P
Institut Mutualiste Montsouris, Paris, France. philippe.girard@imm.fr
Sanchez
Olivier
O
Leroyer
Christophe
C
Musset
Dominique
D
Meyer
Guy
G
Stern
Jean-Baptiste
JB
Parent
Florence
F
D000208:Acute Disease; D000368:Aged; D000792:Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D012307:Risk Factors; D036542:Tomography, Spiral Computed; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology