Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of symptomatic and asymptomatic pulmonary embolism in proximal deep vein thrombosis

근위부 심부정맥 혈전증에서 유증상 폐색전증과 무증상 폐색전증의 비교

  • Kim, Dong Hun (Department of Emergency Medicine, School of Medicine, Daegu Catholic University) ;
  • Seo, Young Woo (Department of Emergency Medicine, School of Medicine, Daegu Catholic University) ;
  • Kim, Gyun Moo (Department of Emergency Medicine, School of Medicine, Daegu Catholic University) ;
  • Ko, Seung Hyun (Department of Emergency Medicine, School of Medicine, Daegu Catholic University) ;
  • Jang, Jae Seok (Department of Cardiothoracic Surgery, School of Medicine, Daegu Catholic University) ;
  • Jang, Tae Chang (Department of Emergency Medicine, School of Medicine, Daegu Catholic University)
  • 김동훈 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 서영우 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 김균무 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 고승현 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 장재석 (대구가톨릭대학교 의과대학 흉부외과학교실) ;
  • 장태창 (대구가톨릭대학교 의과대학 응급의학교실)
  • Received : 2017.10.30
  • Accepted : 2017.11.20
  • Published : 2017.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are conditions with significant morbidity and mortality. Proximal DVT has a significant association with PE and possible fatal outcomes. Traditionally, PE is subdivided into symptomatic PE and asymptomatic PE, which have different treatments, preventions and prognoses. The growing utilization of computed tomography pulmonary angiography has led to increased detection of PE in DVT patients. This study examined the clinical characteristics and compared symptomatic PE and asymptomatic PE following proximal DVT. Methods: The medical records of 258 DVT inpatients from July, 2012 to June, 2015 were reviewed retrospectively. After excluding the patients who did not performed PE evaluation and were not diagnosed with PE, 95 patients diagnosed with PE following proximal DVT were enrolled in this study. They were divided into the symptomatic PE group and asymptomatic PE group. Results: The body weight, body mass index, thrombus size, thrombus length and location were similar in the two groups. The symptomatic PE following proximal DVT group showed an older age, higher incidence of emergency department access (85.0% vs. 38.7%, p<0.001) and preceding infection (25.0% vs. 1.3%, p<0.001) as well as a higher incidence of immobilization (45.0% vs 13.3%, p=0.016). In the multivariate logistic regression study, preceding infection and emergency department access showed significant association with symptomatic PE. Conclusion: In proximal DVT inpatients, symptomatic PE was associated with emergency department access and preceding infection. The possibility of a symptomatic PE event should be considered in proximal DVT patients, especially those who were admitted through the emergency department and had preceding infection.

Keywords

References

  1. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005;51:70-8. https://doi.org/10.1016/j.disamonth.2005.02.003
  2. Cook DJ, Crowther MA. Thromboprophylaxis in the intensive care unit: focus on medical-surgical patients. Crit Care Med 2010;38(2 Suppl):S76-82. https://doi.org/10.1097/CCM.0b013e3181c9e344
  3. Kistner RL, Ball JJ, Nordyke RA, Freeman GC. Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities. Am J Surg 1972;124:169-76. https://doi.org/10.1016/0002-9610(72)90009-8
  4. Stein PD, Matta F, Musani MH, Diaczok B. Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med 2010;123:426-31. https://doi.org/10.1016/j.amjmed.2009.09.037
  5. Tzoran I, Saharov G, Brenner B, Delsart D, Roman P, Visona A, et al. Silent pulmonary embolism in patients with proximal deep vein thrombosis in the lower limbs. J Thromb Haemost 2012;10:564-71. https://doi.org/10.1111/j.1538-7836.2012.04648.x
  6. Civelek AC, Wang EA, Barr L, Urban BA, Eng J. Asymptomatic large main pulmonary artery thromboembolism with a low-probability ventilation-perfusion lung scan. Clin Nucl Med 2001;26:216-20. https://doi.org/10.1097/00003072-200103000-00007
  7. Jung SI, Choi SY, Whang CW. Pulmonary embolism in deep vein thrombosis. J Korean Vasc Surg Soc 1997;13:67-73. Korean.
  8. Boc A, Vene N, Stalc M, Kosmelj K, Mavri A. Unprovoked proximal venous thrombosis is associated with an increased risk of asymptomatic pulmonary embolism. Thromb Res 2014;133:1011-5. https://doi.org/10.1016/j.thromres.2014.02.033
  9. Shteinberg M, Segal-Trabelsy M, Adir Y, Laor A, Vardi M, Bitterman H. Clinical characteristics and outcomes of patients with clinically unsuspected pulmonary embolism versus patients with clinically suspected pulmonary embolism. Respiration 2012;84:492-500. https://doi.org/10.1159/000342324
  10. Stein PD, Afzal A, Henry JW, Villareal CG. Fever in acute pulmonary embolism. Chest 2000;117:39-42. https://doi.org/10.1378/chest.117.1.39
  11. Barba R, Di Micco P, Blanco-Molina A, Delgado C, Cisneros E, Villalta J, et al. Fever and deep venous thrombosis. Findings from the RIETE registry. J Thromb Thrombolysis 2011;32:288-92. https://doi.org/10.1007/s11239-011-0604-7
  12. Frasson S, Gussoni G, Di Micco P, Barba R, Bertoletti L, Nunez MJ, et al. Infection as cause of immobility and occurrence of venous thromboembolism: analysis of 1635 medical cases from the RIETE registry. J Thromb Thrombolysis 2016;41:404-12. https://doi.org/10.1007/s11239-015-1242-2
  13. Pottier P, Hardouin JB, Lejeune S, Jolliet P, Gillet B, Planchon B. Immobilization and the risk of venous thromboembolism. a meta-analysis on epidemiological studies. Thromb Res 2009;124:468-76. https://doi.org/10.1016/j.thromres.2009.05.006
  14. Prokop M. General principles of MDCT. Eur J Radiol 2003;45(Suppl 1):S4-10. https://doi.org/10.1016/S0720-048X(02)00358-3
  15. Laporte S, Mismetti P, Decousus H, Uresandi F, Otero R, Lobo JL, et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008;117:1711-6. https://doi.org/10.1161/CIRCULATIONAHA.107.726232