Download PDF
Thromb Haemost 2002; 88(03): 407-414
DOI: 10.1055/s-0037-1613230
Review Article
Schattauer GmbH

Comparison of Outcomes after Hospitalization for Deep Venous Thrombosis or Pulmonary Embolism

Susan Murin
1   Associate Professor of Clinical Medicine, UC Davis and Veterans’ Administration Northern California Healthcare System
,
Patrick S. Romano
2   Associate Professor of Medicine, UC Davis
,
Richard H. White
3   Professor of Clinical Medicine, UC Davis, USA
› Author Affiliations
Further Information

Publication History

Received 21 January 2002

Accepted after resubmission 06 May 2002

Publication Date:
08 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Venous thrombosis and pulmonary embolism are commonly viewed as different manifestations of a single disease process, venous thromboembolism. Recent evidence suggests that there may be important differences between patients who manifest these two conditions. Using linked hospital discharge records we analyzed 71,250 patients hospitalized with a principal diagnosis of venous thrombosis alone or pulmonary embolism and analyzed predictors of rehospitalization within 6 months for venous thrombosis or pulmonary embolism. There were 51233 patients diagnosed with venous thrombosis alone and 21,625 diagnosed with pulmonary embolism. Comparing patients initially diagnosed with venous thrombosis alone to patients with pulmonary embolism, the relative risk of being rehospitalized with venous thrombosis within 6 months for venous thrombosis was 2.7. Conversely, when patients with pulmonary embolism were compared to patients with venous thrombosis alone, the relative risk of rehospitalization within 6 months with a diagnosis of pulmonary embolism was 4.2. In multivariate models the strongest predictor of recurrent thromboembolism manifest as pulmonary embolism was an initial diagnosis of pulmonary embolism and the strongest predictor of recurrence as venous thrombosis was an initial diagnosis of venous thrombosis. We conclude that the initial clinical manifestation of thromboembolism strongly predicts the manifestation of a recurrence. Venous thrombosis and pulmonary embolism appear to be distinct, albeit overlapping, clinical entities with different natural histories.

Presented at the International Society of Thrombosis and Haemostasis Meeting in Paris, France on July 9, 2001

Keywords

Venous thrombosis - pulmonary embolism
 

  • References

  • 1 Hyers TM, Agnelli G, Hull RD, Morris TA, Samama M, Tapson V, Weg JG. Antithrombotic therapy for venous thromboembolic disease. Chest 2001; 119 (Suppl. 01) 176S-93S.
    CrossrefPubMedGoogle Scholar
  • 2 Hull RD, Hirsh J, Carter CJ, Jay RM, Dodd PE, Ockelford PA, Coates G, Gill GJ, Turpie AG, Doyle DJ, Buller HR, Raskob GE. Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med 1983; 98 (06) 891-9.
    CrossrefPubMedGoogle Scholar
  • 3 Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, d’Azemar P, Simonneau G, Charbonnier B. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med 2000; 160 (02) 159-64.
    CrossrefPubMedGoogle Scholar
  • 4 Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med 1981; 94 (4 pt 1): 439-44.
    CrossrefPubMedGoogle Scholar
  • 5 Ginsberg JS. Management of venous thromboembolism. N Engl J Med 1996; 335 (24) 1816-28.
    CrossrefPubMedGoogle Scholar
  • 6 Vandenbroucke JP, Bertina RM, Holmes ZR, Spaargaren C, van Krieken JH, Manten B, Reitsma PH. Factor V Leiden and fatal pulmonary embolism. Thromb Haemost 1998; 79 (03) 511-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Dunn ST, Trong S. Evaluation of role of factor V Leiden mutation in fatal pulmonary thromboembolism. Thromb Res 1998; 91 (01) 7-14.
    CrossrefPubMedGoogle Scholar
  • 8 Perrier A. Deep vein thrombosis and pulmonary embolism: a single disease entity with different risk factors?. Chest 2000; 118 (05) 1234-6.
    CrossrefPubMedGoogle Scholar
  • 9 Turkstra FR, Karemaker PM, Kuijer MHPrins, Buller HR. Is the prevalence of the factor V Leiden mutation in patients with pulmonary embolism and deep vein thrombosis really different?. Thromb Haemost 1999; 81 (03) 345-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Margaglione M, Brancaccio V, De Lucia D, Martinelli I, Ciampa A, Grandone E, Di Minno G. Inherited thrombophilic risk factors and venous thromboembolism: distinct role in peripheral deep venous thrombosis and pulmonary embolism. Chest 2000; 118 (05) 1405-11.
    CrossrefPubMedGoogle Scholar
  • 11 de Moerloose P, Reber G, Perrier A, Perneger T, Bounameaux H. Prevalence of factor V Leiden and prothrombin G20210A mutations in unselected patients with venous thromboembolism. Br J Haematol 2000; 110 (01) 125-9.
    CrossrefPubMedGoogle Scholar
  • 12 Björgell O, Nilsson PE, Nilsson JA, Svensson PJ. Location and extent of deep vein thrombosis in patients with and without FV:R 506Q mutation. Thromb Haemost 2000; 83 (05) 648-51.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 White RH, Zhou H, Kim J, Romano PS. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. Arch Intern Med 2000; 160 (13) 2033-41.
    CrossrefPubMedGoogle Scholar
  • 14 Meux EF, Stith SA, Zach A. Report of results from the OSHPD reabstracting project: An evaluation of the reliability of selected patient discharge data, July through December 1988. Office of Statewide health Planning and Development; Sacramento, CA: 1990
    Google Scholar
  • 15 White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 1998; 158 (14) 1525-31.
    CrossrefPubMedGoogle Scholar
  • 16 Meux E. Encrypting personal identifiers. Health Serv Res 1994; 29 (02) 247-56.
    PubMedGoogle Scholar
  • 17 White RH, Gettner S, Newman JM, Trauner KB, Romano PS. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med 2000; 343 (24) 1758-64.
    CrossrefPubMedGoogle Scholar
  • 18 White RH, Beyth RJ, Zhou H, Romano PS. Major bleeding after hospitalization for deep-venous thrombosis. Am J Med 1999; 107 (05) 414-24.
    CrossrefPubMedGoogle Scholar
  • 19 Carson JL, Kelley MA, Duff A, Weg JG, Fulkerson WJ, Palevsky HI, Schwartz JS, Thompson BT, Popovich Jr. J, Hobbins TE. et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326 (19) 1240-5.
    CrossrefPubMedGoogle Scholar
  • 20 Douketis JD, Foster GA, Crowther MA, Prins MH, Ginsberg JS. Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy. Arch Intern Med 2000; 160 (22) 3431-6.
    CrossrefPubMedGoogle Scholar
  • 21 Manten B, Westendorp RG, Koster T, Reitsma PH, Rosendaal FR. Risk factor profiles in patients with different clinical manifestations of venous thromboembolism: a focus on the factor V Leiden mutation. Thromb Haemost 1996; 76 (04) 510-3.
    PubMedGoogle Scholar
  • 22 Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivren R, Charbonnier B, Barral FG, Huet Y, Simonneau G. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338 (07) 409-15.
    CrossrefPubMedGoogle Scholar
  • 23 Hulley SB. Designing clinical research: an epidemiologic approach. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001
    Google Scholar
  • 24 Kearon C, Gent M, Hirsh J, Weitz J, Kovacs MJ, Anderson DR, Turpie AG, Green D, Ginsberg JS, Wells P, MacKinnon B, Julian JA, Johnston M, Douketis J, Roberts R, van Nguyen P, Kassis J, Dolan S, Demers C, Desjardins L, Solymoss S, Trowbridge A. A Comparison of Three Months of Anticoagulation with Extended Anticoagulation for a First Episode of Idiopathic Venous Thromboembolism. N Engl J Med 1999; 340 (12) 901-7.
    CrossrefPubMedGoogle Scholar
  • 25 Monreal M, Lafoz E, Ruiz J, Callejas JM, Arias A. Recurrent pulmonary embolism in patients treated because of acute venous thromboembolism: a prospective study. Eur J Vasc Surg 1994; 08 (05) 584-9.
    CrossrefPubMedGoogle Scholar
  • 26 Kniffin Jr. WD, Baron JA, Barrett J, Birkmeyer JD, Anderson Jr. FA. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154 (08) 861-6.
    CrossrefPubMedGoogle Scholar
  • 27 Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA 1998; 279 (06) 458-62.
    CrossrefPubMedGoogle Scholar
  • 28 Price DT, Ridker PM. Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective. Ann Intern Med 1997; 127 (10) 895-903.
    PubMedGoogle Scholar
  • 29 Leroyer C, Mercier B, Escoffre M, Ferec C, Mottier D. Factor V Leiden prevalence in venous thromboembolism patients. Chest 1997; 111 (06) 1603-6.
    CrossrefPubMedGoogle Scholar