Moores Lisa K, Jackson William L, Shorr Andrew F, Jackson Jeffrey L
Uniformed Services University of the Health Sciences, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Ann Intern Med. 2004 Dec 7;141(11):866-74. doi: 10.7326/0003-4819-141-11-200412070-00011.
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.
螺旋计算机断层扫描肺动脉造影（CTPA）在临床上疑似肺栓塞（PE）患者的评估中应用越来越广泛。然而，CTPA作为一种确定性诊断测试，其敏感性可能不足，限制了其应用，特别是在孤立性亚段栓塞的情况下。
评估CTPA结果为阴性的疑似PE患者不进行抗凝治疗的安全性。
在MEDLINE（1966年至2004年3月）和EMBASE（1974年至2004年）以及关键文章的参考文献中检索到的所有相关研究。检索不限于英语文献。
作者选择了所有使用CTPA评估疑似PE并报告了至少3个月随访情况的已发表研究，这些研究中的患者基于CTPA阴性结果未接受抗凝治疗。
两名审阅者根据预定标准独立评估研究质量。提取了关于参与者、CTPA技术、进行的诊断研究、PE患病率、CTPA结果为阴性或不确定且接受随访的患者数量以及随后静脉血栓栓塞和致命PE发生率的数据。
23项研究报告了4657例CTPA结果为阴性且未接受抗凝治疗的患者。随后静脉血栓栓塞事件的3个月发生率为1.4%（95%CI，1.1%至1.8%），致命PE的3个月发生率为0.51%（CI，0.33%至0.76%）。
不同研究中使用的CTPA技术各不相同，且在诊断算法的同一步骤中应用不一致。只有1项研究将CTPA用作唯一的诊断测试。
CTPA结果为阴性后随后发生静脉血栓栓塞的发生率与传统肺动脉造影结果为阴性后的发生率相似。CTPA结果为阴性后不进行抗凝治疗似乎是安全的。
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