Long-term outcome of patients with persistent vascular obstruction on computed tomography pulmonary angiography 6 months after acute pulmonary embolism

Golpe, Rafael; Llano, Luis A. Pérez de; Castro‐Añón, Olalla; Vázquez‐Caruncho, Manuel; González‐Juanatey, Carlos; Fariñas, María Carmen

doi:10.1258/ar.2012.110697

Cited by 22 publications

(28 citation statements)

References 8 publications

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“…Overall, 192 of 1294 patients with RPO had recurrent VTE (14.8%; 95% CI 13.0‐16.8), as compared with 176 of 2178 without RPO (8.1%; 95% CI 7.0‐9.3). The presence of RPO, either on CT angiography or on lung scan, was associated with an increased risk of recurrent VTE without significant heterogeneity (16 studies; 3472 patients; OR according to the random‐effects model, 2.22; 95% CI 1.61‐3.05; I 2 = 26%) (Figure ) . The association was confirmed after amending for zero cells (OR 2.13; 95% CI 1.56‐2.90) and after excluding from the analysis the study by Meneveau et al, in which RPO was assessed at an early stage (OR 2.11; 95% CI 1.52‐2.93).…”

Section: Resultsmentioning

confidence: 82%

“…The association between RPO and recurrent VTE was confirmed in studies assessing RPO on lung scan (11 studies; 2916 patients; OR 2.21; 95% CI 1.63‐3.01; I 2 = 16%), but not in studies assessing RPO on CT angiography, although there was significant heterogeneity (five studies; 556 patients; OR according to the random‐effects model, 2.56; 95% CI 0.82‐7.94; I 2 = 52%) …”

Section: Resultsmentioning

confidence: 95%

“…Overall, 538 papers were found, of which 16 met the inclusion criteria (the flow diagram is shown in Figure S1). In one study, the numbers of patients with or without RPO who had recurrent VTE events were obtained after the authors had been contacted . The agreement between reviewers for study selection was good (kappa statistic of 0.85).…”

Section: Resultsmentioning

confidence: 99%

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Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Becattini

Giustozzi

Cerdà

et al. 2019

Journal of Thrombosis and Haemostasis

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Debated is the role of residual pulmonary obstruction (RPO) in predicting venous thromboembolism. Whether right ventricular dysfunction (RVD) predicts recurrent venous thromboembolism is unknown. 15 studies on RPO and 4 on RVD and venous thromboembolism were included in this meta‐analysis. RPO is a predictor of recurrent venous thromboembolism when assessed by perfusion lung scan. RVD after acute pulmonary embolism is not associated with recurrent venous thromboembolism. Background There is conflicting evidence regarding the role of residual pulmonary obstruction (RPO) or persistent right ventricular dysfunction (RVD) after pulmonary embolism (PE) as a predictor of recurrent venous thromboembolism (VTE). The aim of this study was to assess whether RPO or persistent RVD after PE is associated with recurrent VTE. Methods MEDLINE and EMBASE were searched through December 2018. Studies reporting on (a) RPO either on computed tomography (CT) angiography or perfusion lung scan, or RVD on echocardiography or CT angiography, after therapeutic anticoagulation for the acute PE, and (b) recurrent VTE, were included in this meta‐analysis. Results RPO was associated with an increased risk of recurrent VTE (16 studies; 3472 patients; odds ratio [OR] 2.22; 95% confidence interval [CI] 1.61‐3.05; I2 = 26%); the association was statistically significant for lung scan–detected RPO (11 studies; 2916 patients; OR 2.21; 95% CI 1.63‐3.01) but not for CT angiography–detected RPO (five studies; 556 patients; OR 2.56; 95% CI 0.82‐7.94). No significant association was found between persistent RVD and recurrent VTE (four studies; 852 patients; OR 1.62; 95% CI 0.63‐4.17). Conclusions RPO is a predictor of recurrent VTE after a first acute PE, mainly when assessed by perfusion lung scan.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 95%

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Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Becattini

Giustozzi

Cerdà

et al. 2019

Journal of Thrombosis and Haemostasis

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“…55 Whether residual pulmonary vascular obstruction after PE is a risk factor for recurrence remains unclear. 56 In a cohort of 157 patients, complete PE resolution had occurred in 84.1% of the patients 57 In a different study, Meneveau et al found an association between residual pulmonary vascular obstruction evaluated before hospital discharge and long-term adverse outcome (also recurrent PE). 12 Ongoing studies will probably clarify this issue (NCT01781858).…”

Section: Other Determinants Of Recurrencementioning

confidence: 97%

Acute Pulmonary Embolism after Discharge: Duration of Therapy and Follow-up Testing

Becattini

Franco

Agnelli

2017

Semin Respir Crit Care Med

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Pulmonary embolism (PE) is a frequent cause of death and serious disability with a risk extending far beyond the acute phase of the disease. Anticoagulant treatment reduces the risk for death and recurrent VTE after a first PE. The optimal duration of anticoagulation after a first episode of PE remains controversial and should be made on an individual basis, balancing the estimated risk for recurrence without anticoagulant treatment against bleeding risk under anticoagulation. Current recommendations on duration of anticoagulation are based on a 3% per year risk of major bleeding expected during long-term warfarin treatment. Anticoagulant therapy should be discontinued after the initial 3 to 6 months in those patients who had the first episode in association with temporary risk factors. After 3 to 6 months of anticoagulant treatment, patients with a first unprovoked event and an estimated low risk for bleeding complications should be evaluated for indefinite treatment on an individualized basis. None of the clinical prediction models for recurrent VTE are able to actually drive duration of anticoagulation. If the favorable safety profile of direct oral anticoagulants from clinical trials would be confirmed in real-life, extension of anticoagulation could be reconsidered in large proportions of patients after an unprovoked PE. The most feared late sequela of PE is chronic thromboembolic pulmonary hypertension. Although there has been progress in both the diagnosis and management of this disease in recent years, further data are needed to provide recommendations regarding long-term follow-up after PE.

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“…The study was underpowered to assess short-term outcomes because of a low rate of in-hospital adverse events. However, we followed the long-term evolution of the patients after hospital discharge, and we found that neither residual vascular obstruction on the 6-month computed tomography pulmonary angiography [3] nor persistent echocardiographic signs or right ventricular pressure overload 6 months after the PE [4] predicted long-term adverse outcome events.…”

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confidence: 99%

Prognostic Value of the Charlson Comorbidity Index in Pulmonary Embolism

Golpe¹,

Pérez-de-Llano²,

Castro‐Añón³

2013

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Long-term outcome of patients with persistent vascular obstruction on computed tomography pulmonary angiography 6 months after acute pulmonary embolism

Abstract: Persistent pulmonary vascular obstruction on 6-month CTPA did not predict long-term adverse outcome events.

Cited by 22 publications

References 8 publications

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

Acute Pulmonary Embolism after Discharge: Duration of Therapy and Follow-up Testing

Prognostic Value of the Charlson Comorbidity Index in Pulmonary Embolism

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