Impact of Concomitant Deep Vein Thrombosis on Outcomes of Acute Pulmonary Embolism: Insights from The PERT Consortium Registry

OBJECTIVE: Studies have reported conflicting data regarding the prognostic significance of concomitant deep vein thrombosis (DVT) in acute pulmonary embolism (PE). Understanding the potential differences between PE with and without DVT is crucial for optimizing strategies. METHODS: Using data from The Pulmonary Embolism Response Teams Consortium Registry, this study examined the association between concomitant DVT and clinical outcomes in patients with predominantly acute intermediate- and high-risk PE. A secondary aim was to assess the impact of DVT on treatment selection, particularly the use of advanced therapies. RESULTS: Among 7346 patients with acute PE, 5076 (69%) had concomitant DVT. Patients with DVT were more frequently classified as intermediate-risk compared with patients without DVT, including intermediate-high (59.31% vs 51.9%; P < .001) and intermediate-low risk PE (19.4% vs 17.7%; P < .001). The presence of DVT was significantly associated with higher odds of receiving advanced therapies (odds ratio [OR], 2.49; 95% confidence interval [CI], 2.14-2.81), particularly catheter-directed therapy (OR, 2.44; 95% CI, 2.12-2.83), with the strongest association observed in the intermediate- to high-risk group (OR, 2.67; 95% CI, 2.25-3.18). Concomitant proximal DVT was not associated with increased in-hospital mortality (OR, 0.87; 95% CI, 0.69-1.09), 30-day mortality (OR, 0.96; 95% CI, 0.77-1.20), 1-year mortality (OR, 0.87; 95% CI, 0.73-1.03), or intensive care unit admission (OR, 1.05; 95% CI, 0.93-1.20), after adjustment for advanced therapy use. CONCLUSIONS: In this large contemporary cohort of predominantly intermediate- and high-risk PE, concomitant DVT was common and associated with more severe presentation and greater use of advanced therapies, but not with higher short- or long-term mortality.