Cecilia Becattini1, Alexander T Cohen2, Giancarlo Agnelli1, Luke Howard3, Borja Castejón4, Javier Trujillo-Santos5, Manuel Monreal6, Arnaud Perrier7, Roger D Yusen8, David Jiménez9. 1. Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy. 2. Department of Haematological Medicine, Guys and St. Thomas' NHS Foundation Trust, London, England. 3. National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England. 4. Vascular Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. 5. Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain. 6. Medicine Department, Germans Trias i Pujol Hospital, Badalona, Spain. 7. Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation, and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 8. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO. 9. Respiratory Department, Ramón y Cajal Hospital and Alcala de Henares University, IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
Abstract
BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant DVT lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of concomitant DVT for the primary outcome of 30-day all-cause mortality and the secondary outcome of 90-day PE-related adverse events. We conducted unrestricted searches of PubMed and Embase from 1980 through September 30, 2014, and used the terms "deep vein thrombosis," "pulmonary embolism," and "prognos*." We used a random-effects model to pool study results, Begg rank-correlation method to evaluate for publication bias, and I(2) testing to assess for heterogeneity. RESULTS: The meta-analysis included a total of nine studies (10 cohorts, as one study had two cohorts) with 8,859 patients. Of the seven cohorts with 7,868 participants who had PE and provided results on the primary outcome, 4,379 (56%) had concomitant DVT; 272 of 4,379 (6.2%) patients with concomitant DVT died 30 days after the diagnosis of PE compared with 133 of 3,489 (3.8%) without DVT. Concomitant DVT had a significant association with 30-day all-cause mortality in all patients (seven cohorts; OR, 1.9; 95% CI, 1.5-2.4; I(2) = 0%). Concomitant DVT was not significantly associated with 90-day PE-related adverse outcomes (five cohorts; OR, 1.6; 95% CI, 0.8-3.4; I(2) = 75%). CONCLUSIONS: In patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis.
BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant DVT lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of concomitant DVT for the primary outcome of 30-day all-cause mortality and the secondary outcome of 90-day PE-related adverse events. We conducted unrestricted searches of PubMed and Embase from 1980 through September 30, 2014, and used the terms "deep vein thrombosis," "pulmonary embolism," and "prognos*." We used a random-effects model to pool study results, Begg rank-correlation method to evaluate for publication bias, and I(2) testing to assess for heterogeneity. RESULTS: The meta-analysis included a total of nine studies (10 cohorts, as one study had two cohorts) with 8,859 patients. Of the seven cohorts with 7,868 participants who had PE and provided results on the primary outcome, 4,379 (56%) had concomitant DVT; 272 of 4,379 (6.2%) patients with concomitant DVT died 30 days after the diagnosis of PE compared with 133 of 3,489 (3.8%) without DVT. Concomitant DVT had a significant association with 30-day all-cause mortality in all patients (seven cohorts; OR, 1.9; 95% CI, 1.5-2.4; I(2) = 0%). Concomitant DVT was not significantly associated with 90-day PE-related adverse outcomes (five cohorts; OR, 1.6; 95% CI, 0.8-3.4; I(2) = 75%). CONCLUSIONS: In patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis.
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