计算机断层扫描肺血管扫描的诊断产量在接受抗凝剂治疗的患者中
Payush Chatta1, Brian Diep2, Jakrin Kewcharoen1
1Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92374, USA.
除了静脉血栓栓塞 (VTE) 之外,因其他原因接受抗凝血药 (AC) 的患者在CTPA扫描上肺栓塞 (PE) 的发生率较低. 这一发现表明,AC状态影响PE前测试概率,有助于诊断决策.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 紧急医疗 紧急医疗
背景情况:
- 怀疑肺栓塞 (PE) 患者到急诊室 (ED) 的患者经常接受口服抗凝剂 (AC).
- 在这个人群中,计算机断层扫描肺血管造影 (CTPA) 的诊断实用性尚未明确.
- 了解AC对CTPA产量的影响对于准确的PE诊断至关重要.
研究的目的:
- 调查CTPA在识别PE的诊断产量.
- 确定抗凝血 (AC) 状态如何影响PE阳性CTPA的可能性.
主要方法:
- 一个大学医院的电子病历的回顾性分析ED.
- 包括在2019年6月至2022年3月期间为怀疑PE接受CTPA的患者.
- 主要结局:PE在CTPA的发病率,按AC状态和适应症分层.
主要成果:
- 在2846名患者中,有242名患者在VTE方面接受了AC治疗,210名患者接受了其他适应症治疗,2394名患者没有接受AC治疗.
- 在接受其他指示的AC治疗的患者中,PE发生率明显较低 (5.7%),而不是之前的VTE (24.3%) 或没有AC (9.8%) (P<0.001).
- 多变量分析显示,AC与阳性CTPA (OR0.26;P<0.001) 的可能性较低有关.
结论:
- 在CTPA的肺栓塞 (PE) 发生率在非VTE指示的AC患者中较低,而不是在AC或VTE的AC.
- 抗凝血 (AC) 状态及其指示可能会影响PE的前测试概率.
- 在疑似PE的诊断算法中,应考虑AC状态.
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