Original Article

Phlebology
0(0) 1–9
Pulmonary embolism secondary to deep ! The Author(s) 2021
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venous thrombosis: A retrospective and sagepub.com/journals-permissions
DOI: 10.1177/0268355521990964
observational study for clinical journals.sagepub.com/home/phl

characteristics and risk stratification

Xiaoying Chen, Xian Liu, Jinglun Liu and Dan Zhang

Abstract
Objective: To investigate the risk factors, predilection sites in pulmonary embolism (PE) patients caused by deep
venous thrombosis (DVT) and explore the value of scoring systems in assessing the risk of PE in DVT patients.
Methods: A total of 692 DVT patients were enrolled, and divided into no pulmonary embolism (NPE, 226, 32.66%),
silent pulmonary embolism (SPE, 330, 47.67%) and featuring pulmonary embolism (FPE, 136, 19.65%) groups. For each
group, the differences of clinical data and PE locations were compared, and the risk factors of PE secondary to DVTwere
analyzed. The predictive value of the scoring system for the diagnosis of PE and FPE was evaluated.
Results: PE presented more in the bilateral pulmonary arteries (PAs) (249, 53.43%) and has no significant difference in
PESI scores in different locations. Gender, DVT locations, and previous surgery were the independent risk factors of PE.
DVT locations, previous history of COPD, and previous surgical interventions were the independent risk factors of FPE.
The results for areas under the ROC curves were: AUC(Wells) ¼ 0.675, AUC (Revised Geneva) ¼ 0.601, AUC(D-dimer) ¼ 0.595
in the PE group; AUC(Wells) ¼ 0.722, AUC (Revised Geneva) ¼ 0.643, AUC(D-dimer) ¼ 0.557 in the FPE group.
Conclusions: PE secondary to DVT mostly occurs in the bilateral PAs. Male gender, DVT locations, and previous
surgery increased the risk of PE. The Wells scoring system was more advantageous for evaluating the diagnosis of PE in
patients with DVT.

Keywords
Deep venous thrombosis, pulmonary embolism, risk factors, location

Introduction
Venous thromboembolism (VTE) is a common clinical
disease with an incidence of 100–200 cases per 100,000
people. It mainly manifests as deep venous thrombosis
(DVT) and pulmonary embolism (PE). VTE is the most
common cardiovascular disease underlying acute myo-
cardial infarction and stroke.1,2 PE is a concealed high
mortality disease and is generally considered to be the
result of DVT. The risk factors of PE include two main
categories: inherited and acquired. One of the strongest
risk factors for VTE is a history of prior VTE.3
Approximately 10% of symptomatic acute PE patients
die within 1 h of the first presentation of symptoms; the
mortality rate of untreated PE patients is high at 15%.4
Meanwhile, DVT and PE, which are secondary to
DVT, also cause a huge economic burden to the
social medical system.
The clinical presentation of DVT and PE varies
according to the size of the thrombus and the degree
of embolization. The typical clinical manifestations of
DVT include swelling, pain, fever, and redness of the
affected limb. PE lacks typical clinical presentation, the
most common signs and symptoms include dyspnea,
chest pain, shortness of breath, syncope, and cough.
The First Affiliated Hospital of Chongqing Medical University, Chongqing
400016, China
Corresponding author:
Dan Zhang, Department of Intensive Care Unit, The First Affiliated
Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong
District, Chongqing 400016, China.
Email: doctor_zhangdan@126.com
2 Phlebology 0(0)
It may also manifest as fever, hemoptysis, cyanosis,
hypotension, and shock.5
Thrombus can be distributed into two major areas
in PE, the central vascular area (the main pulmonary
artery (PA) and the left or right PA) and the peripheral
vascular area (segmental or subsegmental PA, not in
the main PA).6 Peripheral PE is defined as thrombus
only in lobar. Clinical manifestations of PE in the
peripheral vascular area are usually mild and atypical;
therefore, diagnosis of VTE based only on clinical
manifestations and signs has great limitations.
Currently, the diagnosis of PE mainly depends on pul-
monary angiography and computed tomography pul-
monary angiography (CTPA). However, the extensive
use of pulmonary angiography or CTPA not only
increases the economic burden, but can also cause
adverse reactions such as unnecessary radiation and
contrast nephropathy.7 Some patients in basic-level
hospitals cannot undergo CTPA examination due to
the limited access in developing countries, so long dis-
tance travel to a more specialized hospital is needed to
undergo CTPA, however, transportation is risky due to
their condition. Therefore, carrying out effective clini-
cal evaluations of DVT patients as a reliable alternative
to imaging examination for those at high risk of PE is
warranted to avoid unnecessary injury and excessive
waste of medical resources caused by extensive imaging
diagnosis technology.
In this study, PE patients with DVT symptoms as
the first manifestation, analyzing PE locations, risk fac-
tors, and the clinical possibility assessments’ score
system was studied, then the possible methods of risk
stratification of PE were discussed.
Patients and methods
Study objects and groups
This was a retrospective and observational study. The
consecutive patients diagnosed with DVT in the First
Affiliated Hospital of Chongqing Medical University
from July 2013 to August 2018 were selected as study
objects. The inclusive criteria were: 1) patients had the
clinical manifestations of DVT (swelling, pain, fever,
and redness of the affected limb), whether followed
by the characteristic clinical manifestations (chest
pain, dyspnea, and hemoptysis) of PE at admission;
2) patients were diagnosed with DVT by Doppler ultra-
sound at admission; 3) CTPA examination was per-
formed in DVT patients, the cases without CTPA
examination were excluded after admission. The color
Doppler ultrasound and CTPA examination were con-
ducted and interpreted by the ultrasound doctor and
the radiologist, respectively. Whether to conduct
CTPA examination was decided by the clinician,
rather than the researcher. Chest pain, dyspnea, and
hemoptysis were defined as the featured clinical presen-
tations of PE. According to CTPA and the clinical pre-
sentation, all of the patients were divided into three
groups: no PE group (NPE) where no PE was found
by CTPA; silent PE group (SPE) where CTPA con-
firmed the presence of PE but it did not have any of
the characteristic manifestations of PE; featuring PE
group (FPE) where CTPA diagnosed the presence of
PE and it presented with one or more of the character-
istic clinical manifestations of PE.
Clinical data collection
General data such as age, gender, and survival status
after 30 days was collected, and the previous medical
history of all patients was recorded. In addition, elec-
trocardiogram, cardiac enzyme levels, pulmonary arte-
rial systolic pressure (PASP), D-dimer, DVT, and PE
locations were recorded in all patients. The Wells score,
Revised Geneva score, and pulmonary embolism sever-
ity index (PESI) were performed on all enrolled
patients, and these score systems were calculated by
two attending doctors among the researchers.
Statistical analysis
Statistical analysis and drawings were performed with
the SPSS 17.0 statistical package software and
GraphPad Prism 5 software. The sample descriptive
statistics data were expressed as means  standard
deviation (x  s), and analyzed with the t-test; the chi-
square test was used to analyze the count data. Using a
binary logistic regression model to analyze risk factors,
an ROC curve was used to evaluate the possibility of
PE. The statistical significance was defined by P < 0.05.
Results
General clinical data of the VTE patients
Of the 2470 consecutive DVT patients screened, there
were 1770 DVT patients without CTPA examination
and eight patients with incomplete clinical data were
excluded. However, 692 patients met the inclusion cri-
teria (Figure 1). The average age of the 692 DVT
patients was 59.59  15.51 years; the number of males
was 373 (53.90%). Among the 692 patients, 226
(32.66%) patients were in the NPE group, 330
(47.69%) cases in the SPE group, and 136 (19.65%)
cases in the FPE group. Four patients died within 30
days in the FPE group.
In this study, there was no significant difference in
age distribution among the three groups. Male patients
accounted for 40.71% (92/226), 60.30% (199/330) and
60.29% (82/136) in the NPE, SPE and FPE groups,
Chen et al.
Figure 1. Patient flow diagram.
DVT: deep venous thrombosis; CTPA: computed tomography pulmonary angiography; PE: pulmonary embolism; SPE: silent pulmonary
embolism; FPE: featuring pulmonary embolism.
respectively, and there were more male cases than
female cases. Moreover, the proportion of DVT in
the right lower extremity was higher in the SPE
group than in the FPE and NPE groups (28.79% >
24.26% > 17.26%); the difference was statistically sig-
nificant compared with the NPE group (P < 0.05). In
patients with coronary heart disease, chronic obstruc-
tive pulmonary disease (COPD), arrhythmia, and other
underlying diseases, PE was more likely to manifest
clinical symptoms. The incidence of pulmonary hyper-
tension in the FPE group was significantly higher than
that in the NPE and SPE groups (Table 1).
Risk factors analysis of PE in patients with DVT
Binary logistic regression analysis was used to identify
independent risk factors for PE and FPE. The results
showed that males (odds ratio (OR) 1.977, 95% confi-
dence interval (CI) 1.404–2.784) with DVT in left lower
limbs (OR 2.078, 95% CI 1.171–3.687) and a surgical
history (OR 2.100, 95% CI 1.220–3.687) (P < 0.05)
were independent risk factors for PE (Table 2).
However, DVT in right lower limbs (OR 1.966, 95%
CI 1.005–3.846) with a surgical history (OR 3.092, 95%
CI 1.553–6.158) and previous history of COPD (OR
0.187, 95% CI 0.085–0.410) were independent risk fac-
tors for FPE (P < 0.05) (Table 3).
Analysis of embolism locations in PE patients
with DVT
Among all PE patients, embolism occurring in bilateral
pulmonary arteries (PAs) was the most common (249,
53.43%), followed by unilateral right PA (158,
3
33.91%), and the least common was unilateral left
PA (59, 12.66%). This distribution pattern appeared
in both the SPE and FPE groups (Figure 2). In the
SPE group, 174 cases (52.73%) had bilateral embolism,
118 cases (35.76%) had right embolism, and 38 cases
(11.52%) had left embolism. In the FPE group, bilat-
eral embolism occurred in 75 cases (55.15%). 40 cases
(29.41%) had right-sided embolism, and 21 cases
(15.44%) had left-sided embolism.
The accurate locations (central and peripheral PAs)
of PE was further analyzed. Results showed that the
embolized areas were mainly distributed in the inferior
lobe of the left lung (50.22%) and the inferior lobe of
right lung (69.74%) in the PE group. The SPE group
embolized areas were also more distributed in the
inferior lobe of lung. However, in the FPE group,
embolism was in the superior lobe of the left lung
(42.65%) and the superior lobe of right lung
(53.68%). Compared with the SPE group, the FPE
group’s emboli occurred more in the pulmonary
trunk and upper lobe of the lung, and less in the
lower lobe; the differences were statistically significant
(Table 4).
Severity levels of PE patients with DVT
In this study, PESI was used to assess the severity and
prognosis of PE patients. It was graded into three risk
classes; I–II – low risk, III–IV – moderate risk, and V –
high-risk. The average PESI scores in all PE
patients were 76.47  27.64, with a large proportion
of low-risk patients (I–II class) (Table 5). PESI scores
for the FPE group were significantly higher than those
4 Phlebology 0(0)

Table 1. Clinical features and outcome of patients with VTE.

Characteristics Total (n ¼ 692) NPE (n ¼ 226) SPE (n ¼ 330) FPE (n ¼ 136)

Age (year) 59.63  15.49 59.58  16.10 59.50  14.93 60.12  16.02
Gender, n of male (%) 373 (53.90%) 92 (40.71%) 199 (60.30%)a 82 (60.29%)a
DVT locations
Left lower limbs, n (%) 438 (63.30%) 168 (74.33%) 189 (57.27%) 81 (59.56%)
Right lower limbs, n (%) 167 (24.13%) 39 (17.26%) 95 (28.79%)a 33 (24.26%)
Bilateral lower limbs, n (%) 87 (12.57%) 19 (8.41%) 46 (13.94%) 22 (16.17%)a
Risk factors
Thrombosis history, n (%) 105 (15.17%) 31 (13.72%) 55 (16.67%) 19 (13.97%)
Hypertension, n (%) 167 (24.13%) 57 (25.22%) 70 (21.21%) 40 (29.41%)
Coronary heart disease, n (%) 54 (7.80%) 17 (7.52%) 20 (6.06%) 17 (12.50%)b
Cancer, n (%) 52 (7.52%) 18 (7.96%) 23 (6.97%) 11 (8.09%)
COPD, n (%) 30 (4.34%) 8 (3.54%) 6 (1.82%) 16 (11.76%)a,b
Previous surgical intervention, n (%) 167 (24.13%) 78 (34.51%) 71 (21.52%)a 18 (13.23%)a
Diabetes, n (%) 79 (11.42%) 27 (11.95%) 36 (10.91%) 16 (11.76%)
Arrhythmia, n (%) 18 (2.60%) 3 (1.33%) 7 (2.12%) 8 (5.88%)a,b
Prolonged bed rest/immobilization, n (%) 241 (34.83%) 94 (41.59%) 106 (32.12%) 41 (30.15%)
Abnormal electrocardiogram 83 (11.99%) 26 (11.50%) 37 (11.21%) 20 (14.71%)
or myocardial enzyme, n (%)
Pulmonary arterial hypertension, n (%) 11 (1.59%) 1 (0.44%) 2 (0.61%) 8 (5.88%)a,b
D-dimer, mg/L 10.38  12.36 9.50  14.82 10.62  10.63 11.28  11.78
Mortality, n (%) 4 (0.58%) 0 (0%) 0 (%) 4 (2.94%)
Represents comparison with NPE group, P < 0.05.
a
b
Represents comparison with SPE group, P < 0.05.
COPD: chronic obstructive pulmonary disease.
Diagnosis of pulmonary hypertension: echocardiography showed PASP > 35 mmHg.8

Table 2. Risk factors for PE in patients with DVT by binary

analysis.

Risk factors OR 95% CI P value

Gender 1.977 1.404–2.784 0.000

Left lower limbs DVT 2.078 1.171–3.687 0.012
Surgical operation 2.100 1.220–3.613 0.007
OR: odds ratio; CI: confidence interval; DVT: deep venous thrombosis.

Table 3. Risk factors for FPE in patients with DVT by binary

analysis.

Risk factors OR 95% CI P value

Left lower limbs DVT 1.736 0.961–3.138 0.068 Figure 2. The number of PE locations in different group.
L: left pulmonary artery; R: right pulmonary artery; D: double
Right lower limbs DVT 1.966 1.005–3.846 0.048
pulmonary artery; PA: pulmonary artery; PE: pulmonary embo-
Surgical operation 3.092 1.553–6.158 0.001
lism; SPE: silent pulmonary embolism; FPE: featuring pulmonary
Arrhythmia 0.367 0.124–1.082 0.069
embolism.
COPD 0.187 0.085–0.410 0.000
Thrombosis history 1.689 0.928–3.072 0.086
CI: confidence interval; OR: odds ratio; COPD: chronic obstructive statistically significant difference in all PE patients,
pulmonary disease. regardless of whether the embolization location
was unilateral or bilateral. Although the PESI of
of the SPE group (86.10  37.20 vs. 70.33  19.82, right PE was higher in the SPE group than the bilateral
P ¼ 0.000). PE (71.88  17.77 vs 69.77  19.57, P ¼ 0.029), they
We further analysis of the relationship between PE were all low risk (class II). There was no statistically
locations and PESI showed that PESI scoring had no significant difference in PESI scores in the FPE group
Chen et al. 5

Table 4. The locations of PE in different groups.

Locations PE (n ¼ 466) SPE (n ¼ 330) FPE (n ¼ 136) P value (FPE vs SPE)

Central PA Main left PA 91 (19.53%) 51 (15.46%) 40 (29.41%) 0.001

Main right PA 128 (27.47%) 82 (24.85%) 46 (33.82%) 0.048
Peripheral PA Left upper lobar PA 124 (26.61%) 66 (20.00%) 58 (42.65%) 0.000
Left inferior lobar PA 234 (50.22%) 182 (55.15%) 52 (38.24%) 0.000
Right upper lobar PA 160 (34.34%) 87 (26.36%) 73 (53.68%) 0.000
Right middle PA 105 (22.53%) 73 (22.12%) 32 (23.53%) 0.741
Right inferior lobar PA 325 (69.74%) 253 (76.67%) 72 (52.94%) 0.000
PA: pulmonary artery; PE: pulmonary embolism; NPE: no pulmonary embolism; SPE: silent pulmonary embolism; FPE: featuring pulmonary embolism;
DVT: deep venous thrombosis.

Table 5. The PESI class of PE in different groups.

PESI class PE (n ¼ 466) SPE (n ¼ 330) FPE (n ¼ 136) P value (SPE vs FPE)

I (65 points) 160 (34.33%) 122 (36.97%) 38 (27.94%) 0.062

II (66–85 points) 193 (41.42%) 152 (46.06%) 41 (30.15%) 0.002
III (86–105 points) 72 (15.45%) 44 (13.34%) 28 (20.59%) 0.049
IV (106–125 points) 21 (4.51%) 11 (3.33%) 10 (7.35%) 0.057
V (>125 points) 20 (4.29%) 1 (0.30%) 19 (13.97%) 0.000
PESI: pulmonary embolism severity index; PA: pulmonary artery; PE: pulmonary embolism; NPE: no pulmonary embolism; SPE: silent pulmonary
embolism; FPE: featuring pulmonary embolism; DVT: deep venous thrombosis.

score 0.675 > D-dimer 0.601 > Revised Geneva score

0.595 > age 0.506; Cut-off values were: Wells score 5,
D-dimer 7.5, Revised Geneva score 10.5, and the age
52.50. The AUC of FPE were: Wells score
0.722 > Revised Geneva score 0.643 > D-dimer
0.557 > age 0.514; Cut-off value were: Wells score 5,
Revised Geneva score 11.5, D-dimer 8.5 and the age
58.50.

Figure 3. PESI score in different groups.
L: left pulmonary artery; R: right pulmonary artery; D: double
pulmonary artery; PE: pulmonary embolism; SPE: silent pulmo-
nary embolism; FPE: featuring pulmonary embolism.
when PE occurred on the left, right, or both sides
(Figure 3).
The ability of various scoring systems to predict PE in
patients with DVT
A relative operating characteristic curve was used to
analyze the predictable values of Wells score, Revised
Geneva score, D-dimer, and age for PE and FPE
groups (Table 6, Figure 4). The results showed that
the Area Under The Curve (AUC) of PE were: Wells
Discussion
VTE, including DVT and PE, causes many cases, and
even deaths, every year. It can occur in all races, ages,
and genders, and is an important and increasingly seri-
ous medical problem.9 Because PE often lacks a typical
clinical manifestations and occurs in the peripheral PAs
in most cases,10 patients can have no clinical symptoms
or signs, therefore, it is difficult to make a diagnosis
based on clinical manifestations alone. Once misdiag-
nosed, PE patients have some potentially serious con-
sequences. The three-month all-cause mortality rate of
acute PE can reach up to 5.4–17%.11,12 Currently,
CTPA is one of the best gold standard tests for the
diagnosis of PE, which can clearly display multistage
and small branches of PA, further improving the diag-
nostic accuracy of PE. However, patients with severe
renal insufficiency, those with allergies to contrast
agents, and pregnant females13,14 should be careful
when tested with CTPA. Access limitations of primary
6 Phlebology 0(0)
Table 6. Wells and revised Geneva scores in different groups.
Clinical scoring system Total (n ¼ 692)
Wells score (low/moderate/high) 4/444/244
Revised Geneva score (low/ moderate/high) 7/310/375
NPE: no pulmonary embolism; SPE: silent pulmonary embolism; FPE: featuring pulmonary embolism.
Figure 4. Receiver-operating characteristic curve of PE(a) and FPE(b).
hospitals in many developing countries requires long-
distance transportation for CTPA examination, which
may further aggravate the disease. Therefore, screening
DVT patients with a high PE risk by using risk factors
or scoring systems can reduce the adverse reactions and
socio-economic burdens caused by generalized CTPA
examination.
In this study, the clinical features of PE patients
caused by DVT were specifically studied. Exclude
active bleeding, malignant hypertension and other con-
ditions, all DVT patients received anticoagulant thera-
py, limb elevation and local immobilization, and PE
patients also accepted anticoagulant therapy under
the condition of stable respiration and circulation.1,12
692 DVT patients were enrolled where approximately
2/3 (67.34%) were diagnosed with PE by CTPA; the
frequency was higher to the data of Prandoni, P. who
conducted a study to investigate the prevalence of PE
among patients hospitalized for syncope.15 The ratio of
FPE to SPE was 1:2.44, and the overall mortality ratio
at 30 days was 0.57%. The ratio of male patients with
PE was higher than female patients, and the incidence
of PE was associated with DVT locations. Moreover,
PE patients with coronary heart disease, COPD,
NPE (n ¼ 226) SPE (n ¼ 330) FPE (n ¼ 136)
4/167/55 0/215/115 0/62/74
6/124/96 1/147/182 0/39/97
arrhythmia, and other basic diseases were more
likely to develop the characteristic clinical symptoms.
These results indicated that FPE was more likely
to occur in male patients, right unilateral or bilateral
DVT patients, and therefore, may require close obser-
vation and further examination to determine the pres-
ence of PE.
There are few studies on the distribution of PE sites
and whether the embolization sites increase the severity
of PE, so the relationship between embolism location
and severity in PE was focused on in this study. The
results showed that PE secondary to DVT occurred
more in bilateral PAs, followed by the right side, and
then the left side. It was speculated that the cause of
this phenomenon might be due to the initiation of
coagulation, by shedding procoagulant lipid micropar-
ticles, or by impairing blood flow in patients with
DVT. It is a process of multiple shedding, and the
caducous thrombosis may be randomly drifted to dif-
ferent PAs on both sides. Because of the heart’s loca-
tion in the left chest cavity, it leads to the anatomical
position of the left PA becoming higher than the right
PA at the PA bifurcation. When the thrombus
detached from a deep vein in the lower extremity and
Chen et al.
entered the left ventricle from the inferior vena cava, it
is more likely to enter the right PA first. Since the right
lung is divided into three lobes while the left lung is
divided into two lobes, the blood flow in the right lung
is higher than that in the left lung. All of the above
reasons cause embolism to occur more frequently in
the right PA than in the left PA.
The study also showed that FPE occurred more fre-
quently in the upper lobe of the lung, while SPE was
mainly in the lower lobe of the lung, which is consid-
ered to be related to the anatomy and functional struc-
ture of the lung.16,17 Ventilation in the upper lobe of
the lung is higher than the lower lobe, and blood flow is
lower in the lower lobe, therefore, embolism occurs
more frequently in the lower lobes of the lung. When
embolism occurs in the upper lobe of the lung, the ven-
tilation function is greatly affected which manifests as
dyspnea as well as other clinical symptoms. However,
the specific reasons need to be further studied.
PESI is a new tool for PE risk and prognosis assess-
ment, and its effectiveness has been widely verified.17,18
Therefore, PESI was chosen as the tool to evaluate the
severity of PE patients in this study. In this research,
the FPE group had more distribution at PESI class III–
IV. In addition, the study results showed that no sig-
nificant difference in PESI score was observed whether
the PE locations were bilateral or unilateral; this is
consistent with the research results conducted by
Valle et al.19 of 269 patients with PE. The result also
reflects the severity assessment of PE requires compre-
hensive consideration of the size, number, location of
emboli, and the presence of underlying diseases in the
heart, lungs, and other organs.
Due to the variability and complexity of clinical
symptoms and signs of PE, clinical diagnosis is still
an important issue for clinicians, especially for medical
institutions without advanced imaging equipment such
as CTPA, or patients with examination risks.
Therefore, an effective clinical score for patients sus-
pected of PE is an important basis for PE diagnosis
strategy.19 Currently, the clinical tools commonly
used to predict the risk of PE include the Wells score,
Revised Geneva score and D-dimer. Although evalua-
tion methods have limitation on diagnosing or exclud-
ing PE, the application of these clinical prediction
methods can make CTPA examination more
targeted.20,21
The Wells score and Revised Geneva score are the
most commonly used scoring systems for PE clinical
probability, which classifies the probability of PE
according to clinical criteria.22–24 Currently, the predic-
tive value of the Wells score and Revised Geneva score
systems for inpatient, emergency, or ICU patients is
highly controversial.25,26 Research has found that the
specificity of the Wells score in predicting PE was lower
7
than the Geneva score, however, the sensitivity was
higher.27,28 In this study, ROC curve showed that the
Wells score, Revised Geneva score and D-dimer all
played certain roles in predicting PE occurrence in
patients with DVT, and that the Wells score has a cer-
tain advantage.
According to the analysis of the cut off value, when
the Wells score was higher than five (5) points, there
was a high probability of PE, and the patients should
consider further examination (CTPA) to confirm the
presence or absence of PE. Therefore, the use of the
Wells score system for PE screening in DVT patients
can avoid unnecessary advanced imaging techniques to
some extent, thereby reducing the economic burden
and adverse reactions caused by it. The expected
value of D-dimer showed no expected value in this
study, which may be related to the lack of age adjust-
ment or because that D-dimer is already increased in
patients with DVT.
Limitations and strengths
This was a retrospective and single center study rather
than a prospective cohort multicenter study. The study
objects were hospital admitted DVT patients due to
symptoms of lower limbs, which may have an element
of bias. An age adjustment for the predictive value
analysis of D-dimer was not carried out. In addition,
the treatment status, including anticoagulation, was
not analyzed after admission.
Conclusion
A high incidence of PE in DVT patients who have
undergone CTPA examination was found. Male
patients, patients with coronary heart disease, COPD,
right or bilateral DVT, and a previous surgical history
are more likely to have PE. In particular, PE occurred
in more bilateral PAs than unilateral PA; unilateral PE
is more common in the right PA than the left PA. For
patients with adverse pulmonary angiography risk, it
was valuable to evaluate the possibility of PE in using
the Wells score.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial sup-
port for the research, authorship, and/or publication of this
article: The authors gratefully acknowledge the National
Natural Science Foundation of China (Grants No.
81071531, No. 81372102) and the Key projects of the
8 Phlebology 0(0)
Chongqing Municipal Health and Family Planning
Commission (Grants No. 2016ZDXM001) for their financial
support.
Ethical approval
This is a retrospective and observational study does, not con-
tain any interests and privacy of patients, and for this type of
study ethical approval is not required.
Guarantor
DZ.
Contributorship
XiaoYing Chen and Dan Zhang contributed to the concept
and design of the research. Xian Liu performed acquisition of
patient data. XiaoYing Chen and Xian Liu performed statis-
tical analyses and wrote the manuscript. JingLun Liu and
Dan Zhang reviewed the manuscript. XiaoYing Chen and
Xian Liu contributed equally to this work and should be
considered as co-first authors.
ORCID iD
Dan Zhang https://orcid.org/0000-0002-1686-2495
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