Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association?

Abstract

Background: The prognostic significance of coexisting deep vein thrombosis (DVT) in acute pulmonary embolism (PE) is controversial. This study aimed to provide routine patient care data on the impact of this association on PE severity and 3-month outcomes in a population presenting with symptomatic venous thromboembolism (VTE) from the REMOTEV registry. Methods and Results: REMOTEV is a prospective, non-interventional study of patients with acute symptomatic VTE, treated with direct oral anticoagulants (DOACs) or standard anticoagulation (vitamin K antagonists (VKA) or parenteral heparin/fondaparinux alone) for at least 3 months. From 1 November 2013 to 28 February 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55–80, 25th–75th percentiles). Patients with PE-associated DVT had more severe forms of PE (p < 0.0001) and, when DVT was present, proximal location was significantly correlated to PE severity (p < 0.01). However, no difference in all-cause mortality rate (hazard ratio (HR) 1.36 (CI 95% 0.69–2.92)), nor in the composite criterion of all-cause mortality and recurrence rate (HR 1.56 (CI 95% 0.83–3.10)) was noted at 3 months of follow-up. Conclusion: In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis.

Clinical Differences and Outcomes of COVID-19 Associated Pulmonary Thromboembolism in Comparison with Non-COVID-19 Pulmonary Thromboembolism

“…These latter results agree with those of previous authors, suggesting that COVID-19-associated PTE involves less PTE-related severity than PTE without COVID-19 [ 22 , 24 ]. In fact, there is some evidence suggesting that PTE’s coexistence with DVT might be related to an increased severity of PTE [ 37 ]. Therefore, the inferior rate of limb pain or edema registered in the COVID-19 group could also be an indirect indicator of a lower severity.…”

Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients – A diagnostic accuracy study

“…In addition to ‘classic’ PE, it is probably multifactorial as COVID-19 patients exhibit all components of Virchow's triad: an immune-mediated hypercoagulable state, endothelial injury, and stasis/turbulence of blood flow (due to immobilization, hypoxemia induced vasoconstriction, and further exacerbated by the insertion of CVCs) [ 3 , 4 , 22 , [47] , [48] , [49] ]. Indeed, PEs are associated with lower limb DVT in only 10–13.6% of COVID-19 patients, while this is 56–61% in undifferentiated cohorts, explaining the lower sensitivity [ 7 , 50 , 51 ]. Specificity is good though, indicating that finding a DVT can make the diagnosis of PE a little more likely, but its absence cannot rule it out.…”

Prevalence of Pulmonary Embolism and Deep Venous Thromboembolism in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

“…The REMOTEV registry demonstrated that patients with PE-related DVT had more severe PE. During DVT, the proximal location is significantly associated with the severity of PE ( 75 ). In patients with isolated acute DVT and initial symptoms, distal DVT is more common in women than that in men.…”