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Letters |3 May 2005

Defining the Role of Computed Tomographic Pulmonary Angiography in Suspected Pulmonary Embolism

Philippe Girard, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Institut Mutualiste Montsouris, 75014 Paris, France.

    Potential Financial Conflicts of Interest: None disclosed.

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TO THE EDITOR:
In their careful and commendable meta-analysis of outcome studies that used CTPA in patients with suspected PE, Moores and colleagues (1) concluded that “it appears to be safe to withhold anticoagulation after negative CTPA results.” I believe that such a message goes beyond the conclusions that can be drawn from the authors' data.
As Moores and colleagues acknowledged, among the 23 outcome studies they analyzed, only 1 used CTPA as the sole diagnostic test. Furthermore, in the 3 largest prospective studies (at least 350 patients in each study remained untreated), anticoagulation was withheld only when both CTPA and compression ultrasonography of the lower limbs yielded negative results (2-4). When it could be calculated, the prevalence of deep venous thrombosis detected by compression ultrasonography in patients with negative CTPA results was very low (0.8%) in 1 study (4), but it was significantly higher in 2 other studies (8.4% and 6.3%, respectively) (2, 5) and reached 18.8% in a study of 117 hospitalized patients (6). Therefore, until specific outcome studies demonstrate the opposite, using CTPA as the sole diagnostic test to withhold anticoagulation in patients with suspected PE should be considered unwise, not “safe.”
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Girard P. Defining the Role of Computed Tomographic Pulmonary Angiography in Suspected Pulmonary Embolism. Ann Intern Med. ;142:801. doi: 10.7326/0003-4819-142-9-200505030-00026

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Published: Ann Intern Med. 2005;142(9):801.

DOI: 10.7326/0003-4819-142-9-200505030-00026

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2005 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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