Abstract
BackgroundThe need for anticoagulation therapy (AC) in patients with subsegmental pulmonary embolism (SSPE) diagnosed by computed tomography of the pulmonary arteries (CTPA) has been questioned, as these patients run low risk for recurrent venous thromboembolism (VTE) during 3 months of follow-up. Whether this applies also to patients with small PE diagnosed with pulmonary scintigraphy has not yet been evaluated, however.MethodsWe therefore retrospectively evaluated 54 patients (mean age 62 ± 19 years, 36 [67 %] women) with small PE diagnosed by ventilation/perfusion singe photon emission computed tomography (V/P SPECT) who did not receive conventional long-term AC.ResultsMore than half of our patients (36[67 %]) received less than 48 h of AC, 11 (20 %) patients were treated for 2–14 days, and 7 (13 %) for 15–30 days. The majority (28 [52 %]) of our patients had a non-low simplified pulmonary emboli severity index (S-PESI), and 7 (13 %) had malignancy. D-dimer was negative in 18 (33 %), positive in 10 (19 %), and not analyzed in 28 (52 %) patients. Phlebography of the lower extremities had been performed with negative result in one patient.During 90 days of follow up no deaths or PE occurred. Seven patients were readmitted to hospital, whereof two (2/54 [4 %]) were diagnosed with deep venous thrombosis (DVT) necessitating AC therapy.ConclusionIn conclusion, withholding longterm AC therapy in patients with SSPE diagnosed by V/P SPECT resulted in 4 % risk for recurrence of VTE during 90 days of follow up, and can therefore currently not be recommended.
Highlights
The need for anticoagulation therapy (AC) in patients with subsegmental pulmonary embolism (SSPE) diagnosed by computed tomography of the pulmonary arteries (CTPA) has been questioned, as these patients run low risk for recurrent venous thromboembolism (VTE) during 3 months of follow-up
In 898 patients diagnosed with PE by V/P ventilation/perfusion single photon emission computed tomography (SPECT), we previously reported risk of recurrence and bleeding in 307 patients with small PE undergoing home treatment with AC [14]
To our knowledge, this is the first retrospective study in which withholding of conventional long-term AC therapy has been clinically evaluated in patients with a diagnosis of small PE made by V/P SPECT
Summary
The need for anticoagulation therapy (AC) in patients with subsegmental pulmonary embolism (SSPE) diagnosed by computed tomography of the pulmonary arteries (CTPA) has been questioned, as these patients run low risk for recurrent venous thromboembolism (VTE) during 3 months of follow-up. Whether this applies to patients with small PE diagnosed with pulmonary scintigraphy has not yet been evaluated, . The use of multiple-detector computed tomography pulmonary angiography (CTPA), has led to an increased. Using planar ventilation-perfusion lung scan (V/Q scan), the majority of patients with suspected PE have non-diagnostic examinations [5].
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