Deep vein thrombosis: silent pulmonary embolism was common.

Clinical bottom line (level 2c)

  1. 40% of patients with a clinical deep vein thrombosis had a silent pulmonary embolism.
Moser et al: Journal of the American Medical Association 1994; 271 (3): 223-225
Expires August 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: five centres, USA

42 patients (aged ?, ?% male) suspected deep vein thrombosis and/or pulmonary embolism
All patients had venogram and ventilation-perfusion scan within 24 hours. Reviewed by two independent radiologists using PIOPED study criteria.


Outcomes studied:
  • silent pulmonary embolism with clinical DVT

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    silent pulmonary embolism with clinical DVT ? 18/42 43%
    (37% to 59%)

    • Seven patients with clinical DVT had PE symptoms and a positive scan.
    • Thirty-seven patients had no chest symptoms, but clinical DVT.
    • Sixteen had a high probability scan.

    Comments

    1. Does it matter? Treatment is the same.
    2. Do patients with a silent pulmonary embolism have a worse prognosis than ones without?

    Citation

    1. Moser KM, Fedullo PF, LitteJohn JK, et al: Frequent asymptomatic pulmonary embolism in patients with deep vein thrombosis. Journal of the American Medical Association 1994; 271 (3): 223-225
    Contributor: Chris Ball and Clare Wotton, August 2000
    Reviewer:

    Clinical Question.
    Patient DVT
    Intervention or Exposure prevalence
    Outcome silent PE