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Negative spiral CT in acute pulmonary embolism
T Nilsson1, A Olausson, H Johnsson
1Department of Thoracic Radiology, Karolinska Hospital, Stockholm, Sweden.
Acta Radiologica (Stockholm, Sweden : 1987)
|November 9, 2002
Summary
Non-anticoagulated patients with suspected pulmonary embolism (PE) and no deep venous thrombosis (DVT) symptoms can safely forgo anticoagulation after a negative CT scan. This approach is safe unless patients are critically ill or have a high clinical suspicion for PE.
Area of Science:
- Radiology
- Cardiology
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
- Deep venous thrombosis (DVT) is a common precursor to PE.
- Accurate diagnosis of PE is crucial for timely and appropriate treatment.
Purpose of the Study:
- To evaluate the clinical outcome of patients with suspected acute PE but no DVT symptoms after a negative contrast-enhanced spiral CT pulmonary angiography (s-CTPA).
- To determine the safety of withholding anticoagulation in this patient group.
Main Methods:
- A retrospective analysis of 739 patients who underwent s-CTPA for suspected acute PE over 24 months.
- Patients with negative s-CTPA results and no DVT symptoms were followed for 3 months for venous thromboembolism (VTE) events.
- Follow-up included questionnaires, interviews, and medical record reviews.
Main Results:
- Of 581 patients with negative s-CTPA, 441 met the criteria for the follow-up cohort (no DVT symptoms, no anticoagulation).
- Four patients (0.9%) in the follow-up cohort experienced VTE (all PE) within 3 months.
- Two of these PE cases were fatal.
Conclusions:
- A negative s-CTPA in patients with suspected PE and no DVT symptoms is a reliable indicator for withholding anticoagulation.
- This strategy is safe for most patients, excluding those who are critically ill, have limited cardiopulmonary reserve, or maintain a high clinical suspicion for PE.