European Journal of Internal Medicine
Volume 21, Issue 4 , Pages 283-288 , August 2010

Safety of withholding anticoagulant therapy in patients with suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography

  • Javier Galipienzo

      Affiliations

    • Servicio de Urgencias, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
    • Javier Galipienzo García and Jaime García de Tena are joint first authors.
  • ,
  • Jaime García de Tena

      Affiliations

    • Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, Spain
    • Corresponding Author InformationCorresponding author.
    • Javier Galipienzo García and Jaime García de Tena are joint first authors.
  • ,
  • Julio Flores

      Affiliations

    • Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
  • ,
  • Concepción Álvarez

      Affiliations

    • Servicio de Diagnóstico por Imagen, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
  • ,
  • Soledad Alonso-Viteri

      Affiliations

    • Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
  • ,
  • Antonio Ruiz

      Affiliations

    • Servicio de Neumología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain

Received 28 September 2009 ,Revised 19 March 2010 ,Accepted 11 May 2010.

References 

  1. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med. 1992;326:1240–1245
  2. Hull RD. Diagnosing pulmonary embolism with improved certainty and simplicity. JAMA. 2006;295:213–215
  3. Stein PD, Henry JW, Gottschalck A. Reassessment of pulmonary embolism for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch. Radiology. 1999;210:689–691
  4. Diffin DC, Leyendecker JR, Johnson SP, et al. Effect of anatomic distribution of pulmonary emboli on interobserver agreement in the interpretation of pulmonary angiography. Am J Roentgenol. 1998;171:1085–1089
  5. Stein PD, Athanasoulis C, Alavi A, et al. Complications and validity of pulmonary angiography in acute pulmonary embolism. Circulation. 1992;85:462–468
  6. Konstantinides S. Acute pulmonary embolism. N Engl J Med. 2008;359:2804–2813
  7. Perrier A, Bounameaux H, Morabia A, et al. Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med. 1996;156:531–536
  8. Perrier A, Miron MJ, Desmarais S, et al. Using clinical evaluation and lung scan to rule out suspected pulmonary embolism: is it a valid option in patients with normal results of lower-limb venous compression ultrasonography?. Arch Intern Med. 2000;160:512–516
  9. Musset D, Parent F, Meyer G, et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet. 2002;360:1914–1920
  10. Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371:1343–1352
  11. Schoepf UJ, Goldhaber SZ, Costello P. Spiral computed tomography for acute pulmonary embolism. Circulation. 2004;109:2160–2167
  12. Gulsun Akpinar M, Goodman LR. Imaging of pulmonary thromboembolism. Clin Chest Med. 2008;29:107–116
  13. Van Strijen MJ, de Monye W, Kiefft GJ, et al. Accuracy of single detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost. 2005;3:17–25
  14. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  15. Perrier A, Roy PM, Sanchez O, et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med. 2005;352:1760–1768
  16. Van Strijen MJ, Bloem JL, de Monye W, et al. Helical computed tomography and alternative diagnosis in patients with excluded pulmonary embolism. J Thromb Haemost. 2005;3:2449–2456
  17. Quiroz R, Kucher N, Zou KH, et al. Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA. 2005;293:2012–2017
  18. Pérez de Llano LA, Veres A, Ortiz M, et al. Safety of withholding anticoagulant therapy in patients who have clinically suspected pulmonary embolism and negative results on helical computed tomography. Respiration. 2006;73:514–519
  19. Garg K, Sieler H, Welsh C, et al. Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment. AJR Am J Roentgenol. 1999;172:1627–1631
  20. Lomis NN, Yoon HC, Moran AG, et al. Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism. J Vasc Interv Radiol. 1999;10:707–712
  21. Swensen SJ, Sheedy PF, Ryu JH, et al. Outcomes after withholding anticoagulation from patients with suspected acute pulmonary embolism and negative computed tomographic findings: a cohort study. Mayo Clin Proc. 2002;77:130–138
  22. Moores L, Jackson W, Shorr A, et al. Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography. Ann Intern Med. 2004;141:866–874
  23. Bourriot K, Couffinhal T, Bernard V, et al. Clinical outcome after a negative spiral CT pulmonary angiographic finding in an inpatient population from cardiology and pneumology wards. Chest. 2003;123:359–365
  24. Ost D, Rozenshtein A, Saffran L, et al. The negative predictive value of spiral computed tomography for the diagnosis of pulmonary embolism in patients with nondiagnostic ventilation–perfusion scans. Am J Med. 2001;110:16–21
  25. Van Belle A, Büller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172–179
  26. Musset D, Parent F, Meyer G, et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicenter outcome study. Lancet. 2002;360:1914–1920
  27. Kruip M, Söhne M, Nijkeuter M. A simple diagnostic strategy in hospitalized patients with clinically suspected pulmonary embolism. J Intern Med. 2006;260:459–466
  28. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98–107
  29. Lensing AWA, Prandoni P, Brandjes D, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989;320:342–345
  30. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354:2317–2327
  31. van Erkel AR, van Rossum AB, Bloem JL, et al. Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis. Radiology. 1996;201:29–36
  32. van Beek EJ, Brouwerst EM, Song B, et al. Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism — a critical review. Clin Radiol. 2001;56:838–842
  33. Schoepf UJ, Goldhaber SZ, Costello P. Spiral computed tomography for acute pulmonary embolism. Circulation. 2004;109:2160–2167
  34. Saad WE, Saad N. Computer tomography for venous thromboembolic disease. Radiol Clin N Am. 2007;45:423–445

 Disclosures: The authors have no conflicts of interest to disclose.

PII: S0953-6205(10)00099-3

doi: 10.1016/j.ejim.2010.05.006

European Journal of Internal Medicine
Volume 21, Issue 4 , Pages 283-288 , August 2010