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Original Research: Pulmonary Vascular Disease |

Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT: Systematic Review and Meta-analysis

Cecilia Becattini, PhD; Alexander T. Cohen, PhD; Giancarlo Agnelli, MD; Luke Howard, PhD; Borja Castejón, MD; Javier Trujillo-Santos, PhD; Manuel Monreal, PhD; Arnaud Perrier, PhD; Roger D. Yusen, MD; David Jiménez, PhD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

CORRESPONDENCE TO: David Jiménez, PhD, Respiratory Department and Medicine Department, Ramón y Cajal Hospital, IRYCIS and Alcala de Henares University, 28034 Madrid, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):192-200. doi:10.1378/chest.15-0808
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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 I2 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; I2 = 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; I2 = 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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