title: Pulmonary embolism in ischemic stroke: clinical presentation, risk factors, and outcome.
abstract: BACKGROUND
  Limited information is available on the frequency of pulmonary embolism (PE) in patients with an acute ischemic stroke (AIS). We evaluated clinical characteristics, predisposing factors, and outcomes in AIS patients with PE.
  
  
  RESULTS
  We included all AIS patients admitted to participating institutions in the Registry of the Canadian Stroke Network. Clinically PE was documented by a physician and confirmed by computed tomography pulmonary angiography within 30 days of the stroke case index. The primary outcome was death or disability at discharge. Secondary outcomes included disposition, length of hospital stay, mortality at 3 months and 1 year. Among 11 287 patients with AIS, PE was found in 89 (0.78%) patients. History of cancer, deep vein thrombosis (DVT)/PE, and DVT during the hospitalization were associated with PE. PE was associated with higher risk of death at 30 days (25.8% versus 13.6%; P<0.001), at 1 year (47.2% versus 24.6%; P<0.001), and disability at discharge (85.4% versus 63.6%; P<0.001). Mean length of stay was longer in stroke patients with PE (36 versus 16 days; P=0.001). After adjusting for age, sex, and stroke severity, PE remained associated with lower survival at 30 days and 1 year, and death or disability at discharge (OR 3.02; 95% CI 1.56 to 5.83).
  
  
  CONCLUSIONS
  In this large cohort study, PE occurred in nearly 1% of AIS patients. PE was more common in patients with severe stroke, history of cancer, previous DVT/PE or acute DVT and associated with lower short- and long-term survival, greater disability, and longer length of stay.
authors.affiliation: Stroke Outcomes Research Center, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: Jitphapa
authors.initials: J
authors.lastname: Pongmoragot
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Yongchai
authors.initials: Y
authors.lastname: Nilanont
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
authors.forename: Limei
authors.initials: L
authors.lastname: Zhou
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D016017:Odds Ratio; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology
keywords: cerebral infarction; pulmonary embolism; stroke; venous thromboembolism