title: History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism.
abstract: BACKGROUND
  Pulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities.
  
  
  OBJECTIVE
  We aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT.
  
  
  METHODS
  Data from the observational multi-center thrombEVAL-study were analyzed.
  
  
  RESULTS
  The sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed.
  
  
  CONCLUSIONS
  History of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Keller
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Jürgen H
authors.initials: JH
authors.lastname: Prochaska
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Coldewey
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Gobel
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ullmann
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany.
authors.forename: Heidrun
authors.initials: H
authors.lastname: Lamparter
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany.
authors.forename: Liana
authors.initials: L
authors.lastname: Ariza
authors.affiliation: Department of Medicine I, Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.affiliation: Department of Internal Medicine III, Hospital of Barmherzige Brüder Trier, Trier, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lauterbach
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.affiliation: Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany; Preventive Cardiology and Preventive Medicine, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: philipp.wild@unimedizinmainz.de.
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000150:complications*
keywords: Atrial fibrillation; Deep vein thrombosis; Pulmonary embolism; Risk factors; Venous thromboembolism