Lisa K. Moores, MD; William L. Jackson Jr., MD; Andrew F. Shorr, MD, MPH; Jeffrey L. Jackson, MD, MPH
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the U.S. Department of Defense.
Acknowledgments: The authors thank Christopher Bennett, MD, for his expertise with CTPA and Mr. Robert J. Mohrman for his assistance with the literature search.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Lisa K. Moores, MD, Uniformed Services University of the Health Sciences, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307; e-mail, Lisa.Moores@na.amedd.army.mil.
Current Author Addresses: Drs. Moores, W.L. Jackson, and Schorr: Uniformed Services University of the Health Sciences, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307.
Dr. J.L. Jackson: Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.
Spiral computed tomographic pulmonary angiography (CTPA) is increasingly being used in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, CTPA as a definitive diagnostic test may be limited by inadequate sensitivity, especially in instances of isolated subsegmental emboli.
To assess the safety of withholding anticoagulation in patients with suspected PE and negative results on CTPA.
All relevant studies identified in MEDLINE (1966 to March 2004) and EMBASE (1974 to 2004) and in bibliographies of key articles. The search was not limited to the English language.
The authors selected all published studies that used CTPA to evaluate suspected PE and reported at least 3 months of follow-up in patients not receiving anticoagulation on the basis of a negative CTPA result.
Two reviewers independently rated study quality on the basis of predetermined criteria. Data were extracted on participants, CTPA technique, diagnostic studies performed, prevalence of PE, number of patients with negative or indeterminate CTPA results who were followed, and subsequent rates of venous thromboembolism and fatal PE.
Twenty-three studies reported on 4657 patients with negative CTPA results who did not receive anticoagulation. The 3-month rate of subsequent venous thromboembolic events was 1.4% (95% CI, 1.1% to 1.8%), and the 3-month rate of fatal PE was 0.51% (CI, 0.33% to 0.76%).
The CTPA technology used varied across studies and was not applied uniformly in the same step of diagnostic algorithms. Only 1 study used CTPA as the sole diagnostic test.
The rate of subsequent venous thromboembolism after negative results on CTPA is similar to that seen after negative results on conventional pulmonary angiography. It appears to be safe to withhold anticoagulation after negative CTPA results.
Moores LK, Jackson WL, Shorr AF, et al. Meta-Analysis: Outcomes in Patients with Suspected Pulmonary Embolism Managed with Computed Tomographic Pulmonary Angiography. Ann Intern Med. 2004;141:866–874. doi: https://doi.org/10.7326/0003-4819-141-11-200412070-00011
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Published: Ann Intern Med. 2004;141(11):866-874.
Emergency Medicine, Pulmonary Embolism, Pulmonary/Critical Care, Venous Thromboembolism.
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