Deep venous thrombosis in patients with acute pulmonary embolism - Prevalence, risk factors, and clinical significance

Study objectives: 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. Design: Post hoc analysis of data from a prospective multicenter outcome study of 1,041 patients with clinically suspected nonsevere PE. All patients underwent CTPA and CUS within 24 h of enrollment and were followed up for 3 months. Patients: 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 DN'T symptoms for CUS-detectable DVT were 43% and 85%, respectively. Multivariate analysis showed that an age >= 70 years (odds ratio [OR], 1.90; 95% C1, 1.14 to 3.17) and the presence of DN'T signs or symptoms (OR, 4.12; 95% CI, 2.24 to 7.55) were independent risk factors for positive CUS results. DN'T 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 DN'T. 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). Conclusion: These results do not support screening for DNT 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.