ORIGINAL ARTICLE  VENOUS DISEASE Free access

International Angiology 2022 August;41(4):338-45

DOI: 10.23736/S0392-9590.22.04842-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Prognostic significance of symptomatic deep vein thrombosis in patients with acute symptomatic pulmonary embolism regarding the European Society of Cardiology mortality risk model

Slobodan D. OBRADOVIC ^{1, 2}, Boris M. DZUDOVIC ³, Bojana N. SUBOTIC ¹, Jelena M. DZUDOVIC ⁴ ✉, Jovan A. MATIJASEVIC ^{5, 6}, Marija D. BENIC ⁵, Jadranka L. TROBOK ⁵, Sandra M. PEKOVIC ⁵, Sonja S. SALINGER-MARTINOVIC ⁷, Ljiljana Z. JOVANOVIC ⁸, Ljiljana V. KOS ⁹, Tamara KOVACEVIC-PRERADOVIC ⁹, Stefan M. SIMOVIC ¹⁰, Vladimir M. MILORADOVIC ¹⁰, Ana M. KOVACEVIC-KUZMANOVIC ¹¹, Tanja D. MRDJAN ¹¹, Bjanka Z. BOZOVIC ¹², Nebojsa S. BULATOVIC ^{12, 13}, Srdjan V. KAFEDZIC ¹⁴, Sasa S. PANCEVACKI ¹⁵, Aleksandar N. NESKOVIC ^{14, 16}

¹ Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; ² School of Medicine, University of Defense, Belgrade, Serbia; ³ Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia; ⁴ National Poison Control Center, Military Medical Academy, Belgrade, Serbia; ⁵ Institute for Pulmonary Diseases of Vojvodina, Vojvodina, Serbia; ⁶ School of Medicine, University of Novi Sad, Novi Sad, Serbia; ⁷ Clinic of Cardiology, Clinical Center Nis, University of Nis, Nis, Serbia; ⁸ Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia; ⁹ Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Republic of Serbia, Bosnia and Herzegovina; ¹⁰ Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, Kragujevac, Serbia; ¹¹ Department for Internal Medicine, General Hospital of Pancevo, Pancevo, Serbia; ¹² Clinic of Cardiology, Clinical Center of Podgorica, Podgorica, Montenegro; ¹³ School of Medicine Podgorica, University of Podgorica, Podgorica, Montenegro; ¹⁴ Department of Cardiology, Clinical Hospital Center of Zemun, Zemun, Serbia; ¹⁵ Intensive Care Unit, Clinic of Internal Medicine, Clinical Hospital Center of Zemun, Zemun, Serbia; ¹⁶ School of Medicine Belgrade, University of Belgrade, Belgrade, Serbia

BACKGROUND: Deep vein thrombosis (DVT) can be symptomatic or asymptomatic in patients with acute pulmonary embolism (PE). The prognostic value of the symptomatic DVT at the presentation regarding the prognosis of PE is unknown.
METHODS: Data were extracted from the REgional Pulmonary Embolism Registry (REPER) which enrolled 1604 hospitalized patients after multidetector computed tomography (MDCT) diagnosed symptomatic acute PE. According to the ESC risk model, patients were classified into four subgroups. Patients who had leg edema with or without pain, and patients with leg pain and DVT confirmed by compression ultrasound were considered to have symptomatic DVT. This study aimed to compare all-cause hospital mortality between patients with symptomatic DVT and patients without symptoms or signs of DVT across the PE risk stratums.
RESULTS: All-cause mortality in patients with symptomatic DVT compared to those who had no symptoms or signs of DVT were 2/196 (1.0%) vs. 11/316 (3.5%), P=0.145, 4/129 (3.1%) vs. 17/228 (7.5%), P=0.106, 14/196 (7.1%) vs. 54/290 (18.6%), P<0.001 and 16/55 (29.1%) vs. 51/139 (36.7%), P=0.402 in patients with low, intermediate-low, intermediate-high and high-risk PE, respectively. In multivariate analysis symptomatic DVT was associated with decreased in-hospital mortality only in patients with intermediate-high PE (OR 0.320, 95%CI 0.164-0.627; P=0.001). Intermediate-high risk PE patients with symptomatic DVT who were treated with thrombolysis had significantly lower hospital mortality than patients without symptoms or signs of DVT (2.2% vs. 11.4%, P=0.003).
CONCLUSIONS: Intermediate-high risk PE patients with symptomatic DVT at presentation may benefit from thrombolysis and have lower hospital all-cause mortality in such circumstances.

KEY WORDS: Venous thrombosis; Pulmonary embolism; Prognosis; Mortality