Should we look for silent pulmonary embolism in patients with deep venous thrombosis?

BMC Cardiovascular Disorders

Research Article

Maria José Fabia¹  Elena Furió¹  Gernot Pichler¹  Maria José Forner¹  Fernando Martínez²  Josep Redon²  Maria José García-Fuster³ 

[1] Internal Medicine, Hospital Clínico Universitario, Valencia, Spain;Research Institute, INCLIVA, University of Valencia, Valencia, Spain;Internal Medicine, Hospital Clínico Universitario, Valencia, Spain;Research Institute, INCLIVA, University of Valencia, Valencia, Spain;CIBERObn, Carlos III Health Institute, Madrid, Spain;Internal Medicine, Hospital Clínico Universitario, Valencia, Spain;Research Institute, INCLIVA, University of Valencia, Valencia, Spain;Servicio Medicina Interna, H.Clinico Universitario Valencia, Avda Blasco Ibañez n°17, 46010, Valencia, Spain;

关键词: Pulmonary embolism;    Deep vein thrombosis;    D-dimer;   

DOI  :  10.1186/1471-2261-14-178

 received in 2014-03-06, accepted in 2014-11-11,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAsymptomatic or silent pulmonary embolism (S-PE) in patients with deep vein thrombosis has been the focus of numerous publications with the objective of determining the incidence of S-PE and assessing whether its existence has any clinical or therapeutic consequences that outweigh the risks associated with the diagnostic tests performed and the increased healthcare costs. The objectives were to assess the incidence of S-PE using computed tomography angiogram (CTA), to understand the epidemiological factors that might trigger embolism, and to assess whether D-dimer (DD) predicts the existence of S-PE’s.MethodsA prospective and consecutive assessment of 103 hospitalized patients with lower limb DVT in the absence of PE symptoms, using CT scan. DD was quantified before anticoagulation. The risk factors and characteristics of the DVT were studied. A three-year follow-up assessing risk recurrence and clinical outcome was performed.ResultsThe incidence of S-PE was 66%. In 77% of these cases, the main and lobar pulmonary arteries were affected. Iliac and femoral DVTs most often produced S-PE. ROC curve with a DD value higher than 578 ng/ml provided good sensitivity but low specificity to identify patients with S-PE. Diagnosis entailed higher hospitalization expenses. No significant recurrence rate of thrombotic events was observed in the S-PE group during the follow-up.ConclusionsThe incidence of S-PE in lower-limb DVT is high, but in the absence of symptoms, diagnosis does not appear to be necessary, as there are no short- or long-term clinical or therapeutic consequences.

【 授权许可】

CC BY   
© García-Fuster et al.; licensee BioMed Central. 2014