Assessment of coexisting deep vein thrombosis for risk stratification of acute pulmonary embolism

Abstract Background In patients with acute pulmonary embolism ( PE ), studies have shown an association between coexisting deep vein thrombosis ( DVT ) and short-term prognosis. It is not known whether complete compression ultrasound testing ( CCUS ) improves the risk stratification of their disease beyond the recommended prognostic models. Methods We included patients with normotensive acute symptomatic PE and prognosticated them with the European Society of Cardiology ( ESC ) risk model for PE. Subsequently, we determined the prognostic significance of coexisting DVT in patients with various ESC risk categories. The primary endpoint was a complicated course after the diagnosis of PE, defined as death from any cause, haemodynamic collapse, or adjudicated recurrent PE. Results According to the ESC model, 37% of patients were low-risk, 56% were intermediate-low risk, and 6.7% were intermediate-high risk. CCUS demonstrated coexisting DVT in 375 (44%) patients. Among the 313 patients with low-risk PE, coexisting DVT (46%) did not show a significant increased risk of complicated course (2.8%; 95% confidence interval [ CI ], 0.8%–7.0%), compared with those without DVT (0.6%; 95% CI, 0%–3.2%), ( P  = 0.18). Of the 478 patients with intermediate-low risk PE, a complicated course was 14% and 6.8% for those with and without DVT, respectively ( P  = 0.01). Of the 57 patients that had intermediate-high risk PE, a complicated course occurred in 17% and 18% for those with and without DVT, respectively ( P  = 1.0). Conclusions In normotensive patients with PE, testing for coexisting DVT might improve risk stratification of patients at intermediate-low risk for short-term complications.