Patient outcomes after deep vein thrombosis and pulmonary embolism

Background: Despite advances in the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), relatively few contemporary data describe and compare outcomes in patients with these common conditions from a more generalizable community-based perspective. The purpose of this study was to measure and compare clinical characteristics and outcomes of patients with validated symptomatic PE and isolated DVT in a New England community. Methods: The medical records of residents from the Worcester area with International Classification of Diseases, Ninth Revision (ICD-9) codes consistent with possible venous thromboembolism (VTE) during 1999,2001, and 2003 were independently validated and reviewed by trained abstractors. Results: Patients who presented with PE or isolated DVT experienced similar rates of subsequent PE, overall VTE, and major bleeding during 3-year follow-up (5.9% vs 5.1% vs 17.9%, and 15.6% vs 12.4%, respectively). Mortality was significantly increased at 1-month follow-up in patients who initially presented with PE (13.0% vs 5.4%); this difference persisted at 3 years (35.3% vs 29.6%). Patients whose course was complicated by major bleeding were more likely to experience recurrent VTE or to die at 3 years than those without these complications. Conclusions: Patients who presented with PE had similar rates of subsequent PE or recurrent VTE compared with patients with isolated DVT. However, rates of recurrent VTE and major bleeding after DVT and PE remain unacceptably high in the community setting. Efforts are needed to identify patients most at risk for VTE-associated complications and to develop better anticoagulation strategies conducive to long-term use in the community setting.