Treatment Of Single Peripheral Pulmonary Emboli: Patient Outcomes And Factors Associated With Decision To Treat

Abstract

The incidence of pulmonary embolism (PE) has risen dramatically with the institution of multi-detector CT scanning with Rationale: angiography (CTA) that has revealed more single peripheral pulmonary embolism (SPPE) than observed with prior diagnostic methods. Because the mortality associated with these single small presumed clots may be lower than that historically associated with PE, the rationale underlying treatment is murky.To determine the association between treatment of SPPE with 90 day mortality and VTE recurrence and to analyze the factors Aim: associated with decision to treat.Retrospective analysis of all cases with CTA for detection of PE that identified a SPPE over 66 month period. Markov chain Monte Methods: Carlo method was used for analysis of mortality and bootstrap method was employed for analysis of decision to treat. A SPPE was defined as a single segmental or subsegmental filling defect that was interpreted by the radiologist as a PE. Treatment was either by anticoagulation or IVC filter placement.156 of 4906 CTAs for PE revealed a SPPE. Thirteen cases were unavailable for review, 8 had DVT, and 36 were not concluded in the Results: radiology report to be indicative of PE, yielding 99 cases for analysis. Fifty-nine (60%) received treatment (3 with IVC filter) with no difference in adjusted 90 day mortality compared to untreated patients ( 0.0206, 95%CI -1.44 to 1.47 effect size of the treatment ). Recurrent VTE within 90 days was recorded in 4 (4%) patients, 3 untreated and one treated, which were too few to show a significant treatment effect. No patient experienced a major bleeding event during hospitalization. Patient factors associated with a significant probability (mean probability > 0.5) for treatment were immobility (0.77), previous VTE (0.70), and absence of mental status change (0.64) but not vital sign abnormality, co-morbid illnesses, history of cancer, or pulmonary consultation. SPPE Conclusion: The majority of patient with received treatment with no demonstrable association with improved 90 day mortality. Although this is the largest data set yet analyzed, recurrence of VTE was too infrequent to determine a treatment effect. A multicenter study is required to adequately investigate this endpoint. History of previous VTE and immobility appeared to sway the treatment decision, while only absence of mental status change among physical conditions was associated with a higher probability of treatment. This abstract is funded by: None Am J Respir Crit Care Med 185;2012:A2375 Internet address: www.atsjournals.org Online Abstracts Issue