Low risks of pulmonary embolism in patients with blood clots in the brain

Av Irina Starikova
Stipendiat ved TREC

Pulmonary embolism (PE) is a serious, life-threatening complication of venous thrombosis – blood clots in the veins. Some patients with pulmonary embolism may suffer from chest pain, shortness of breath and cough, while the others do not have any presentations of disease. In severe cases, PE can lead to death.

Most commonly, PE occurs when a piece of a blood clot (embolus) which is carried in the bloodstream reaches the lung and blocks its artery.  The embolus usually arises from a clot that originates in the deep veins of the lower extremities. In some cases, clots may also break off from the other sites in the body, including large-capacity channels with venous blood in brain called the cerebral venous sinuses.

A study recently published in the journal Stroke aimed to estimate the risk of PE in patients with cerebral venous thrombosis (CVT), a blood clot in the brain, compared to that in patients with deep vein thrombosis (DVT), which is a clot usually developed in the leg. Dr. Liberman and coauthors retrospectively reviewed the administrative data from the emergency department visits and hospitalizations in three regions of the US (California, New York, Florida) in the period between 2005 and 2013. The “cohort of interest” included all patients who were primarily diagnosed with either CVT or DVT, were residents of the mentioned regions, and did not have cases of PE earlier.

The authors estimated the rate of PE during the first-time hospitalization and measured the rate of PE during the follow-up in both study groups. In general, patients with CVT were younger than patients with DVT, they were mostly females, and had fewer risk factors for venous blood clots compared to patients with DVT. Researchers found that the risk of PE was much lower in patients with CVT than among patients with DVT. Interestingly, even though the overall risk of PE is low in CVT patients, the greatest chance of getting PE was during the primary hospitalization. The investigators showed similar results for both groups when they excluded patients with history of cancer and pregnant women from the analysis.

The study by Liberman and coauthors suggests that early detection of CVT and initiation of treatment is important since most PE events occur the during first-time hospitalization. Further studies on CVT are needed to improve therapeutic strategies for PE prevention.

Reference: Liberman AL, Merkler AE, Gialdini G, Messé SR, Lerario MP, Murthy SB, Kamel H, Navi BB. Risk of Pulmonary Embolism After Cerebral Venous Thrombosis. Stroke (2017). 

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