Isolated pulmonary embolism may predict long-term arterial thrombosis risk
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Key takeaways:
- Diagnosis of isolated pulmonary embolism may indicate presence of CVD and long-term risk for arterial thrombosis.
- Isolated pulmonary embolism “should be recognized as a separate clinical entity.”
Data from a systematic review suggest that adults with isolated pulmonary embolism, the majority of whom are women, are more likely to have prevalent CVD and are at increased risk for arterial thrombosis.
“Isolated PE appears to be associated with a different clinical profile and risks than deep vein thrombosis-associated PE,” Philipp S. Wild, MD, MSc, of University Medical Center of the Johannes Gutenberg University Mainz, Germany, and colleagues wrote. “It is unclear whether isolated PE should be considered a separate clinical entity that potentially requires alternative therapy.”
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Wild and colleagues performed a systematic review and meta-analysis of 50 studies with 435,768 patients with PE, comparing PE phenotypes and pooling data on risk factors, clinical characteristics and clinical endpoints. Systematic DNA analysis was performed in 13 studies.
The findings were published in eClinicalMedicine.
Among studies with low risk for bias, 30% of patients had isolated PE. Most patients with isolated PE (57%) were women. Factor V Leiden (OR = 0.47; 95% CI, 0.37-0.58) and prothrombin G20210A mutations (OR = 0.55; 95% CI, 0.41-0.75) were less prevalent among patients with isolated PE.
Compared with patients with DVT-associated PE, patients with isolated PE were more likely to be women (OR = 1.3; 95% CI, 1.17-1.45), have had recent invasive surgery (OR = 1.31; 95% CI, 1.23-1.41), have MI history (OR = 2.07; 95% CI, 1.85-2.32), have left-sided HF (OR = 1.7; 95% CI, 1.37-2.1), peripheral artery disease (OR = 1.36; 95% CI, 1.31-1.42) and diabetes (OR = 1.23; 95% CI, 1.21-1.25).
In a synthesis of clinical outcome data, the risk for recurrent venous thromboembolism in isolated PE was half that of patients with DVT-associated PE (RR = 0.55; 95% CI, 0.44-0.69), although a single study accounted for 65% of the pooled estimate, according to researchers. Risk for arterial thrombosis was nearly threefold higher among patients with isolated PE compared with those with DVT-associated PE, with an RR of 2.93 (95% CI, 1.43-6.02).
“Irrespective of thrombus origin, the results of this study suggest that isolated PE should be recognized as a separate clinical entity, and a diagnosis of isolated PE should be considered a tentative biomarker for an increased risk for arterial thrombosis,” the researchers wrote. “While outcome data are still very limited, ample cross-sectional data suggest that patients diagnosed with isolated PE, even in the face of potential misclassification, are at increased risk of cardiovascular disease. Conversely, the risk of recurrent VTE appears to be much lower for isolated PE patients.”
The researchers noted that randomized controlled trials are needed to determine whether alternative treatment regimens may be beneficial for this common patient subgroup.
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