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Deep Venous Thrombosis in Patients With Acute Pulmonary Embolism^*

Prevalence, Risk Factors, and Clinical Significance

^* From the Institut Mutualiste Montsouris (Dr. Girard), Paris; Hôpital Européen Georges Pompidou (Drs. Sanchez and Meyer), Paris; Hôpital de la Cavale Blanche (Dr. Leroyer), Brest; Hôpital Antoine Béclère (Dr. Parent), Clamart; and Hôpital Beaujon (Dr. Stern), Clichy, France.

Correspondence to: Philippe Girard, MD, FCCP, Département thoracique, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France; e-mail philippe.girard{at}imm.fr

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 DVT symptoms for CUS-detectable DVT were 43% and 85%, respectively. Multivariate analysis showed that an age 70 years (odds ratio [OR], 1.90; 95% CI, 1.14 to 3.17) and the presence of DVT signs or symptoms (OR, 4.12; 95% CI, 2.24 to 7.55) were independent risk factors for positive CUS results. DVT 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 DVT. 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 DVT 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.

Key Words: deep venous thrombosis • diagnosis • Doppler • duplex • prognosis • pulmonary embolism • spiral CT • ultrasonography