Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association?
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design and Patient Selection
2.2. Requirements for VTE Diagnosis
2.3. Baseline Variables
2.4. Treatment Regimens
2.5. Follow-Up and Outcome Assessment
2.6. Statistical Analysis
3. Results
3.1. Baseline Characteristics and Deep Vein Thrombosis Prevalence
3.2. DVT and PE Severity Assessment
3.3. Risk Factors Associated with PE Severity
3.4. Concomitant DVT and Risk of Poor Outcomes after a 3-Month Follow-Up
4. Discussion
Author Contributions
Conflicts of Interest
References
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Total N (%)/M ± SD/ M (Q1–Q3) | PE with DVT N (%)/M ± SD/ M (Q1–Q3) | PE without DVT N (%)/M ± SD/ M (Q1–Q3) | p-Value | |
---|---|---|---|---|
N | 1037 | 727 (70.1) | 310 (29.9) | |
Age (years) | 69 (55–80) | 71 (57–80) | 67 (50–78) | 0.002 |
Age ≥ 70 years old | 499 (48.1) | 368 (50.6) | 131 (42.3) | 0.008 |
Male | 493 (47.5) | 361 (49.7) | 132 (42.6) | 0.04 |
Weight (kg) N = 1018 | 77.5 (67–188) | 78 (67–167) | 77 (68–188) | 0.47 |
Weight ≤ 50 kg | 31 (3) | 18 (2.5) | 13 (4.3) | 0.19 |
BMI (kg/m2) N = 987 | 27 (24–31) | 27 (24–31) | 27 (24–31) | 0.91 |
BMI ≥ 30 kg/m2 | 324 (32.8) | 230 | 94 | 0.69 |
eGFR (mL/min/1.73 m2) on admission | 85.5 (67.2–104.3) | 83 (65.1–100.7) | 91.9 (70.8–112.2) | 0.0001 |
eGFR ≥ 90 | 460 (44.4) | 294 (40.4) | 166 (53.7) | |
60 ≤ eGFR < 90 | 381 (37.8) | 285 (39.2) | 96 (31.1) | |
30 ≤ eGFR < 60 | 166 (16) | 125 (17.2) | 41 (13.3) | |
eGFR < 30 | 29 (2.8) | 23 (3.2) | 6 (1.9) | |
CrCl Cockcroft (mL/min) on admission | 85.2 (58.7–119.6) | 81.7 (55.5–114.1) | 90.9 (64.7–128.4) | 0.001 |
CrCl < 50 mL/min | 177 (17.4) | 137 (19.2) | 40 (13.2) | 0.02 |
Cardiovascular risk factors | ||||
Hypertension | 563 (54.3) | 418 (57.5) | 145 (46.8) | 0.001 |
Diabetes | 165 (15.9) | 115 (15.8) | 50 (16.1) | 0.97 |
Dyslipidemia | 344 (33.2) | 251 (34.5) | 93 (30) | 0.17 |
Smoking (history or current) | 417 (41.2) | 287 (40.3) | 130 (43.3) | 0.40 |
Medical history | ||||
Previous thromboembolism | 332 (32) | 230 (31.6) | 102 (33) | 0.71 |
PAD | 32 (3.1) | 20 (2.8) | 12 (3.9) | 0.71 |
CAD | 62 (5.9) | 41 (5.6) | 21 (6.8) | 0.57 |
COPD | 56 (5.4) | 32 (4.4) | 24 (7.7) | 0.04 |
Active cancer. total | 89 (8.6) | 68 (9.4) | 21 (6.8) | 0.21 |
Known thrombophilia | 41 (3.9) | 24 (3.3) | 17 (5.5) | 0.13 |
Antithrombotic treatment on admission | ||||
Antiplatelet | 202 (19.6) | 131 (18.1) | 71 (22.9) | 0.08 |
Anticoagulation | 66 (6.4) | 40 (5.5) | 26 (8.4) | 0.11 |
PE severity | ||||
Low risk | 364 (35.1) | 220 (30.3) | 144 (46.5) | <0.0001 |
Intermediate low | 397 (38.3) | 279 (38.4) | 118 (38.1) | |
Intermediate high | 249 (24) | 202 (27.8) | 47 (15.1) | |
High risk | 27 (2.6) | 26 (3.5) | 1 (0.3) | |
DVT location | ||||
Lower limbs | 717 (69.1) | 717 (98.6) | - | |
Bilateral | 127 (12.2) | 127 (17.5) | - | |
Proximal | 454 (43.8) | 454 (62.4) | - | |
Distal | 263 (25.3) | 263 (36.2) | - | |
Unusual site | 25 (2.4) | 25 (3.4) | - | |
Isolated | 10 (1) | 10 (1.4) | - | |
Type of VTE | ||||
Unprovoked | 613 (59.1) | 430 (59.1) | 183 (59) | 1 |
IVC filter | 13 (1.2) | 12 (1.6) | 1 (0.3) | 0.12 |
PE Thrombolysis/-ectomy/-aspiration | 18 (1.7) | 17 (2.4) | 1 (0.3) | 0.02 |
Anticoagulant treatment at discharge | ||||
DOAC | 756 (72.9) | 528 (72.6) | 228 (73.5) | 0.81 |
VKA | 135 (13) | 92 (12.6) | 43 (13.9) | 0.66 |
LMWH/Fondaparinux | 145 (14) | 106 (14.6) | 39 (12.6) | 0.44 |
No anticoagulant | 1 (0.1) | 1 (1.4) | 0 | 1 |
Anticoagulant treatment duration | ||||
3 months | 93 (8.9) | 53 (7.2) | 40 (12.9) | 0.007 |
6 months | 474 (45.7) | 342 (47) | 132 (42.6) | 0.21 |
Indefinite | 469 (45.2) | 331 (45.6) | 138 (44.5) | 0.81 |
Risk Factor | Unadjusted HR (95% CI) | p–Value | Adjusted HR (95% CI) | p–Value |
---|---|---|---|---|
Age > 70 years old | 7.02 (5.15–9.65) | <0.001 | 4.85 (3.46–6.87) | <0.001 |
Female sex | 1.47 (1.13–1.92) | <0.01 | 1.41 (1.04–1.91) | <0.05 |
High blood pressure | 3.42 (2.60–4.52) | <0.001 | 1.56 (1.12–2.17) | <0.01 |
Diabetes | 1.84 (1.24–2.77) | <0.01 | 0.95(0.60–1.52) | NS |
eGFR < 60 mL/min/1.73 m2 | 5.35 (3.34–8.95) | <0.001 | 2.70 (1.64–4.61) | <0.001 |
Cancer | 26.82 (7.12–225.30) | <0.001 | 30.64 (9.30–189.37) | <0.001 |
COPD | 3.41 (1.57–8.45) | <0.001 | 4.00 (1.82–9.83) | <0.01 |
Ischemic heart disease | 3.36 (1.62–7.86) | <0.001 | 1.50 (0.69–3.56) | NS |
Presence of DVT | 1.99 (1.50–2.65) | <0.001 | 2.03 (1.47–2.82) | <0.001 |
Known thrombophilia | 0.36 (0.18–0.72) | <0.01 | 0.88 (0.42–1.77) | NS |
Outcome | Total n = 1037 | DVT n = 727 | DVT-Free n = 310 | HR (CI 95%) | p-Value |
---|---|---|---|---|---|
All-cause death | 50 | 38 | 12 | 1.36 (0.69–2.92) | 0.42 |
VTE recurrence | 21 | 15 | 6 | 1.28 (0.44–4.55) | 0.80 |
Major bleeding | 34 | 23 | 11 | 0.88 (0.40–20.4) | 0.70 |
Clinically relevant non-major bleeding | 59 | 40 | 19 | 0.89 (0.49–1.65) | 0.66 |
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Cordeanu, E.-M.; Lambach, H.; Heitz, M.; Di Cesare, J.; Mirea, C.; Faller, A.-M.; Cavaro, A.-C.; Frantz, A.-S.; Gaertner, S.; Schini-Kerth, V.; et al. Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association? J. Clin. Med. 2019, 8, 899. https://doi.org/10.3390/jcm8060899
Cordeanu E-M, Lambach H, Heitz M, Di Cesare J, Mirea C, Faller A-M, Cavaro A-C, Frantz A-S, Gaertner S, Schini-Kerth V, et al. Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association? Journal of Clinical Medicine. 2019; 8(6):899. https://doi.org/10.3390/jcm8060899
Chicago/Turabian StyleCordeanu, Elena-Mihaela, Hélène Lambach, Marie Heitz, Julie Di Cesare, Corina Mirea, Alix-Marie Faller, Anne-Cécile Cavaro, Anne-Sophie Frantz, Sebastien Gaertner, Valérie Schini-Kerth, and et al. 2019. "Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association?" Journal of Clinical Medicine 8, no. 6: 899. https://doi.org/10.3390/jcm8060899
APA StyleCordeanu, E.-M., Lambach, H., Heitz, M., Di Cesare, J., Mirea, C., Faller, A.-M., Cavaro, A.-C., Frantz, A.-S., Gaertner, S., Schini-Kerth, V., & Stephan, D. (2019). Pulmonary Embolism and Coexisting Deep Vein Thrombosis: A Detrimental Association? Journal of Clinical Medicine, 8(6), 899. https://doi.org/10.3390/jcm8060899