The risk of developing pulmonary embolism in patients with deep vein thrombosis depends on DVT size and factors related to pain, with less painful DVTs being more often associated with PE.
Larger, less symptomatic DVTs may heighten PE suspicion clinically; leaves open validation for risk stratification in prospective cohorts.
Pain and swelling of the leg have been studied in 27 patients with deep vein thrombosis (DVT). Twenty-three of them were also examined for pulmonary embolism (PE) after one week of heparin treatment. Scoring systems were constructed to quantitate pain, size of DVT and PE. A ratio between swelling and pain (S/P ratio) was calculated for each patient. Actual size of the DVT, as estimated with venous phlebography, was correlated to swelling (rs = 0.51, p less than 0.01), S/P ratio (rs = 0.53, p less than 0.01) and PE (rs= 0.57, p less than 0.01). DVTs with not pain at all or just tenderness on palpation were more often associated with PE (p less than 0.05) and elevated blood pressure (p = 0.02) than DVTs with pain on walking. A free floating proximal end of DVT proved unreliable for predicting PE. It is concluded that the risk of developing PE depends not only on DVT size, but also on factors related to pain.
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Lundh et al. (1981) studied this question.
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