Pulmonary Embolism and Proximal DVT Associated With Increased Short-Term Mortality

Patients with acute pulmonary embolism (PE) and proximal deep vein thrombosis (DVT) at diagnosis have a higher risk for 90-day all-cause mortality compared with PE patients without DVT, according to a study in the Journal of Cardiology.

The COMMAND VTE registry enrolled 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE) in Japan. The current study population included 655 acute patients with PE (mean age 66.6±15.4 years; 61% female) who had lower extremities ultrasound examination at diagnosis to assess for concomitant DVT status.

A total of 424 patients had proximal DVT (64.7%), 162 patients had distal DVT (24.7%), and 69 patients had no DVT (10.5%). The cumulative 90-day incidence of all-cause death was higher among proximal DVT patients than for distal DVT patients and patients with no DVTs (7.9%, 2.5%, and 1.4%, respectively, P =.01).

The cumulative 90-day incidence of PE-related death was low and not significantly different in the proximal DVT, distal DVT, and no DVT groups (1.4%, 0.6%, and 1.7%, respectively, P =.62). The most frequent cause of death in proximal and distal DVT patients was cancer. No significant differences were observed in the 90-day rates of recurrent VTE and major bleeding, regardless of concomitant DVT status (2.9%, 3.2%, and 2.2%, respectively, P =.79, and 1.5%, 4.4%, and 4.9%, respectively, P =.46).

“Acute PE with proximal DVT at diagnosis was associated with a higher risk for short-term mortality than in those patients without DVT, while the risk for short-term mortality was not significantly different between distal DVT patients and patients without DVT,” the researchers stated.

Patients with proximal DVT were more likely to have active cancer compared with patients with distal DVT or no DVT, which was consistent with a previous study, according to the study authors. “VTE is strongly associated with cancer, as it is reported to be detected in 10.4% of newly diagnosed lung cancer patients,” they stated.

Study limitations include the retrospective cohort and observational study design. Also, management strategies were left to the discretion of the attending physicians, which could influence the clinical outcomes, and the study excluded patients without lower extremities ultrasound examination.

“Considering the relatively high prevalence of residual DVT in acute PE patients, clinicians might have to be careful for the assessment of the presence or absence of concomitant DVT in acute PE patients,” the researchers commented. “The current study showed that the proportion of men was relatively higher in proximal DVT patients.”

Disclosures: The study received research funding from Mitsubishi Tanabe Pharma Corporation, and some of the authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Nishiwaki S, Morita Y, Yamashita Y, et al. Impact of no, distal, and proximal deep vein thrombosis on clinical outcomes in patients with acute pulmonary embolism: from the COMMAND VTE registry. Published online November 17, 2020. J Cardiol. doi: 10.1016/j.jjcc.2020.10.019