Impact of Asymptomatic Pulmonary Embolism on the Long-Term Prognosis of Patients with Deep Venous Thrombosis

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Abstract

Asymptomatic pulmonary embolism (PE) is present in at least one-third of patients with deep venous thrombosis (DVT). However, knowledge about its influence on the prognosis of patients is limited. The aim of this study was to assess the prognostic impact of asymptomatic PE in patients with DVT and to explore risk factors for recurrent venous thromboembolic events. A total of 200 consecutive patients with the first episode of objectively confirmed DVT without symptoms of PE were included. All patients underwent ventilation-perfusion scintigraphy within 48 hours of DVT confirmation. Patients with inconclusive scans further underwent computed tomography pulmonary angiography. At the time of inclusion and 4 weeks after discontinuation of anticoagulation, the levels of biomarkers of hemostasis and inflammation were assessed. Patients were followed up for a mean period of 4.2 ± 0.6 years. Recurrent episodes of venous thromboembolisms were recorded. Consistent with the literature, asymptomatic PE was present in 33.5% of the patients. During follow-up, 27 recurrent venous thromboembolisms were recorded, 20 presenting as DVT and 7 as symptomatic PE. Asymptomatic PE wasn't significantly associated with the rate of recurrence (p = 0.676). Recurrent events were associated with unprovoked versus provoked DVT (hazard ratio [HR]: 5.01; 95% confidence interval [CI]: 2.25-11.17; p < 0.001) and with increased versus normal D-dimer values, measured 4 weeks after discontinuation of anticoagulation (HR: 6.47; 95% CI: 2.96-14.17; p < 0.001).

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