Silent PE raises risk for early symptomatic PE in DVT patients
MedWire News: Patients with silent pulmonary embolism (PE) at the time of deep vein thrombosis (DVT) diagnosis have an increased risk for symptomatic PE during the first 2 weeks of therapy, study findings indicate.
In those with no PE, however, the incidence of major bleeding far exceeds the incidence of symptomatic PE, report Manuel Monreal (Hospital Universitario Germans Trias i Pujol, Barcelona, Spain) and colleagues in the Journal of Thrombosis and Haemostasis.
"This suggests that less aggressive anticoagulant therapy might be indicated during the first 2 weeks of treatment for DVT patients with no PE," they add.
The researchers explain that the clinical relevance of silent PE in patients with DVT has not been thoroughly studied.
To address this, they analyzed data on 2375 patients with symptomatic proximal DVT and no PE symptoms from the Registro Informatizado de Enfermedad Trombo Embólica (RIETE).
All patients underwent screening with either ventilation-perfusion lung scan or helical computed tomography when they presented with DVT, and silent PE was identified in 35% (n=842).
The researchers compared the clinical characteristics, diagnostic tests, and clinical outcome between patients with silent PE and those with no PE.
They found that patients presenting with silent PE had a significantly higher incidence of symptomatic PE events during the first 15 days of anticoagulation than those with no PE at presentation (0.95 vs 0.13%). The incidence of major bleeding was similar between the groups, at 0.95% versus 1.63%.
Although there was only a relatively small percentage difference in symptomatic PE incidence between the two groups, multivariate analysis showed that the risk for developing this condition was almost fivefold higher in patients with silent PE at baseline, compared with those with no PE.
The researchers also highlight the fact that the risk for bleeding was a substantial eightfold higher than the risk for symptomatic PE among patients with no PE at baseline, whereas the bleeding and PE risks were equal in those with silent PE at baseline.
This suggests that the intensity of anticoagulation "may be optimal" to reduce the combined outcome of PE and bleeding among patients with silent PE, but may be too aggressive in those with no PE at baseline. "However, randomized trials would need to establish that less aggressive anticoagulant therapy was superior to standard anticoagulant therapy before the former could be recommended," the authors caution.
By 90 days, the incidence of symptomatic PE was similar between the groups, at 1.78% among patients presenting with silent PE versus 1.04% among patients presenting with no PE.
"Our data suggest that screening for silent PE in DVT patients at increased risk for bleeding may be useful in some subgroups of patients with DVT, such as those with contraindications for anticoagulation (recent major bleeding, abnormal coagulation tests, or renal insufficiency)," Monreal and team conclude.
By Laura Cowen