• Karsten Keller, Jürgen H Prochaska, Meike Coldewey, Sebastian Gobel, Alexander Ullmann, Claus Jünger, Heidrun Lamparter, Liana Ariza, Christoph Bickel, Michael Lauterbach, Stavros Konstantinides, Thomas Rostock, Thomas Münzel, and Philipp S Wild.
• Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany.
• Thromb. Res. 2015 Nov 1; 136 (5): 899-906.

BackgroundPulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities.ObjectivesWe aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT.Patients/MethodsData from the observational multi-center thrombEVAL-study were analyzed.ResultsThe sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed.ConclusionsHistory of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.Copyright © 2015. Published by Elsevier Ltd.

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