Gualtiero Palareti1, Emilia Antonucci2, Francesco Dentali3, Daniela Mastroiacovo4, Nicola Mumoli5, Vittorio Pengo6, Daniela Poli7, Sophie Testa8, Pietro Luigi Pujatti9, Vincenzo Giannicola Menditto10, Davide Imberti11, Andrea Fontanella12. 1. Arianna Anticoagulazione Foundation, Bologna, Italy. Electronic address: gualtiero.palareti@unibo.it. 2. Arianna Anticoagulazione Foundation, Bologna, Italy. 3. Department of Clinical Medicine, Insubria University, Varese, Italy. 4. Angiology Unit, SS Filippo and Nicola Hospital, Avezzano, L'Aquila, Italy. 5. Medicina Generale, Ospedale Civile, Magenta (MI), Italy. 6. Cardiology Clinic, Thrombosis Centre, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. 7. Thrombosis Centre, AOU Careggi, Firenze, Italy. 8. Hemostasis and Thrombosis Center, Department of Laboratory Medicine, AO Istituti Ospitalieri, Cremona, Italy. 9. UOC Medicina Generale, Ospedale di Arzignano, Vicenza, ULSS8 Berica, Italy. 10. SOD Pronto soccorso e medicina d'Urgenza, Ospedali Riuniti di Ancona, Italy. 11. Medicina Interna ERI, Ospedale Civile, Piacenza, Italy. 12. Dipartimento di Medicina e Pronto Soccorso, Ospedale Fatebenefratelli, Napoli, Italy.
Abstract
BACKGROUND: Patients with acute pulmonary embolism (PE) often have leg deep vein thrombosis (DVT); sometimes, however, a DVT is not detected (isolated PE, I-PE). We aimed at assessing the proportion of patients with I-PE, and their characteristics and clinical evolution compared to those with DVT with/without PE (DVT/PE). METHODS: Among 3573 patients included in the START2-Register for a venous thromboembolic event, 2880 (80.6%) had DVT/PE, the remaining I-PE (19.4%). RESULTS: Patients with I-PE were older [(≥75 years, OR 1.4 (95%CI 1.13-1.69)], and more frequently females [OR 1.4 (1.19-1.67)]. Young females (aged ≤ 50 years) with an index event occurring during hormonal contraception (HC), were more prevalent in I-PE [OR 1.96 (1.26-3.03)]. At multivariate analysis, age > 75 years, female sex, heart failure, cancer and use of HC were risk factors significantly associated with I-PE, whereas thrombophilic alterations were associated with DVT/PE. During a follow-up of 4504 years (during anticoagulation), the rate of bleeding events was 1.1% patient/years and 1.0% patient/years in I-PE and DVT/PE, respectively. Venous thromboembolic events were equally prevalent in DVT/PE or I-PE (1.94% vs 0.86%, ns), whereas arterial complications were more prevalent in the latter group (1.01% vs 0.28%, p = 0.008). CONCLUSION: I-PE and DVT/PE have important differences. Older age, female sex, heart failure and cancer, were risk factors for I-PE; thrombophilic alterations were associated with DVT/PE. HC use was more frequent in the I-PE group. The prevalence of arterial complications was higher in patients with I-PE. Further studies, specifically designed on this issue, are warranted.
BACKGROUND:Patients with acute pulmonary embolism (PE) often have leg deep vein thrombosis (DVT); sometimes, however, a DVT is not detected (isolated PE, I-PE). We aimed at assessing the proportion of patients with I-PE, and their characteristics and clinical evolution compared to those with DVT with/without PE (DVT/PE). METHODS: Among 3573 patients included in the START2-Register for a venous thromboembolic event, 2880 (80.6%) had DVT/PE, the remaining I-PE (19.4%). RESULTS:Patients with I-PE were older [(≥75 years, OR 1.4 (95%CI 1.13-1.69)], and more frequently females [OR 1.4 (1.19-1.67)]. Young females (aged ≤ 50 years) with an index event occurring during hormonal contraception (HC), were more prevalent in I-PE [OR 1.96 (1.26-3.03)]. At multivariate analysis, age > 75 years, female sex, heart failure, cancer and use of HC were risk factors significantly associated with I-PE, whereas thrombophilic alterations were associated with DVT/PE. During a follow-up of 4504 years (during anticoagulation), the rate of bleeding events was 1.1% patient/years and 1.0% patient/years in I-PE and DVT/PE, respectively. Venous thromboembolic events were equally prevalent in DVT/PE or I-PE (1.94% vs 0.86%, ns), whereas arterial complications were more prevalent in the latter group (1.01% vs 0.28%, p = 0.008). CONCLUSION: I-PE and DVT/PE have important differences. Older age, female sex, heart failure and cancer, were risk factors for I-PE; thrombophilic alterations were associated with DVT/PE. HC use was more frequent in the I-PE group. The prevalence of arterial complications was higher in patients with I-PE. Further studies, specifically designed on this issue, are warranted.
Authors: Abby M Pribish; Sebastian E Beyer; Anna K Krawisz; Ido Weinberg; Brett J Carroll; Eric A Secemsky Journal: Vasc Med Date: 2020-11-17 Impact factor: 3.239