History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolismâ˜

- History of DVT is a discriminator for clinical profile in PE
- Patients with concomitant history of DVT had less often coronary artery disease, atrial fibrillation and pulmonary disease
- Atrial fibrillation was strongly associated with isolated PE and might play a role in pathophysiology of isolated PE
- The ORs for atrial fibrillation increased with longer periods of continued arrhythmia for the association with isolated PE
- Patients with history of PE and atrial fibrillation had a poorer outcome in comparison to those without atrial fibrillation

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 Registration: URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.