Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation

Jiménez, David; Agustí, Àlvar; Tabernero, Eva; Jara‐Palomares, Luis; Hernando, Ascensión; Ruiz-Artacho, Pedro; Pérez-Peñate, Gregorio; Rivas-Guerrero, Agustina; Rodríguez-Nieto, María Jesús; Ballaz, Aitor; Agüero, Ramón; Jiménez, Sònia; Rubio, Myriam Calle; López‐Reyes, Raquel; Marcos, Pedro J.; Barrios, Deisy; Rodrı́guez, Carmen; Muriel, Alfonso; Bertoletti, Laurent; Couturaud, Francis; Huisman, Menno V.; Lobo, José Luís; Yusen, Roger D.; Bikdeli, Behnood; Monréal, Manuel; Otero, Remedios; Vilas, Andrés; Aisa, Diego; González-Quero, Beatriz; Chasco, Leyre; León-Marrero, Fernándo; Domínguez-Pazos, Santiago de Jorge; Quezada, Andrés; Granda‐Orive, José Ignacio de; Beddar-Chaib, Fahd; Fernández-Ormaechea, Itzíar; Rodríguez-Hermosa, José Luis; Carriel-Mancilla, Jorge; Martínez-Verdasco, A.; Miguel‐Díez, Javier de; Quesada, María Angustias; Márquez-Martín, Eduardo

doi:10.1001/jama.2021.14846

Cited by 40 publications

(26 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study might have practical implications. The SLICE trial showed that an active diagnostic strategy for PE is not beneficial among patients hospitalized for an exacerbation of COPD [ 11 ]. However, D-dimer is often used in daily practice as a screening test in patients admitted to the Emergency Departments with chest symptoms [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…SLICE was a multicenter, open-label, randomized, clinical trial aimed at evaluating whether an active search for PE might improve clinical outcomes in patients with exacerbations of COPD who required hospital admission. The rationale, design and main results of the SLICE study were described previously [ 11 , 12 ]. The trial was conducted in 18 academic hospitals across Spain.…”

Section: Methodsmentioning

confidence: 99%

“…Though PE has been reported to be prevalent in patients with exacerbation of chronic obstructive pulmonary disease ( COPD ) [ 7 – 10 ], the S ignificance of Pu l monary Embolism i n C OPD E xacerbations ( SLICE ) showed that an active strategy for the diagnosis of PE (D-dimer testing and, if positive, CTPA) did not result in a lower percentage of patients experiencing the composite outcome of venous thromboembolism ( VTE ), readmission for COPD, or death within 90 days after randomization [ 11 ]. In daily practice, however, D-dimer testing is frequently ordered for the initial assessment of the patients presenting with chest symptoms (including those with COPD exacerbations).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background For patients with suspected pulmonary embolism (PE), age- or clinically-adjusted D-dimer threshold level can be used to define a negative test that safely excludes PE and reduces the use of imaging. However, the utility of this approach in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation is undefined. Methods We ran an analysis of the patients hospitalized for COPD exacerbation and randomized to the intervention in the SLICE trial. Using the conventional strategy as the reference, we compared the proportion of patients with a negative D-dimer result, and the negative predictive value and sensitivity of three D-dimer threshold strategies for initial PE or subsequent diagnosis of venous thromboembolism (VTE): the age-adjusted strategy, the Wells-adjusted strategy, and the YEARS-adjusted strategy. Results We included 368 patients. Using a conventional threshold, 182 (49.5%) patients had negative D-dimer values, of whom 1 (0.6%) had PE (sensitivity, 94.1%). The use of an age-adjusted threshold increased the number of patients in whom PE could be excluded from 182 to 233 patients (63.3%), and the proportion of false-negative findings increased from 0.5% to 1.7% (sensitivity, 76.5%). With the use of the Wells or YEARS strategies, 64.4% and 71.5% had negative values, and the proportion of false-negative findings was 2.5% (sensitivity, 64.7%) and 2.7% (sensitivity, 58.8%), respectively. Conclusions In patients hospitalized for COPD exacerbation, compared with the conventional strategy, age- or clinically-adjusted strategies of D-dimer interpretation were associated with a larger proportion of patients in whom PE was ruled out with a higher failure rate. Trial Registration ClinicalTrials.gov number: NCT02238639.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent study published by Jiménez et al assessed whether active research of pulmonary embolism by D-Dimer dosing and computed pulmonary angiogram in hospitalized patients for COPD exacerbations is followed by a reduction in the composite risk of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days. 40 In the analysis were included 370 actively investigated cases, compared to 367 cases that received the usual care. Standard therapy included administration of oxygen, bronchodilators, antibiotics and prophylactic thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

“…The SLICE trial 40 revealed that anticoagulant treatment in hospitalized patients for exacerbation of COPD, actively investigated for pulmonary embolism, does not bring additional benefits to prophylactic therapy. This finding substantially supports the arguments regarding the administration of prophylactic treatment to patients with COPD, as recommended by the Global Initiative for Chronic Obstructive Lung Disease in patients with severe COPD.…”

Section: Introductionmentioning

confidence: 99%

COPD and Anticoagulation Therapy: Time for a New Approach?

Petriș¹,

Fildan²,

Cojocaru³

2021

COPD

View full text Add to dashboard Cite

Chronic obstructive pulmonary disease (COPD) is one of the most challenging chronic disease nowadays due to increased morbidity and mortality, despite the multiple new therapies included in the therapeutic scheme. A possible cause may be insufficient approach to thromboembolic risk in these patients, scientific data being so far insufficient and relatively controversial. Areas covered: anticoagulant therapy is used mainly during severe exacerbations. There are data that have shown that therapy with low weight heparins injectable anticoagulants causes not only a reduction in thromboembolic risk but also an improvement in respiratory function parameters. Expert opinion: a number of COPD phenotypes are more prone to procoagulant status and thrombus formation. A layered approach to COPD patients in terms of antithrombotic prophylaxis is needed. Although current published clinical data have not provided irrefutable evidence, possibly due to the relatively heterogeneous approach to inclusion criteria, the frequent identification of autopsy holes in patients with COPD suggests that the high risk of mortality is due to specific bronchopulmonary changes and pulmonary embolism.

show abstract

A Pulmonary Embolism Diagnostic Strategy in Patients Hospitalized for COPD Exacerbation

Xiong

Guo

2022

JAMA

View full text Add to dashboard Cite

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation

Cited by 40 publications

References 29 publications

Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial

Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial

COPD and Anticoagulation Therapy: Time for a New Approach?

A Pulmonary Embolism Diagnostic Strategy in Patients Hospitalized for COPD Exacerbation

Contact Info

Product

Resources

About