Yoo Hugo H B, Queluz Thais H A T, El Dib Regina
Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Distrito de Rubiao Junior, s/n, Campus de Botucatu, Botucatu, Sao Paulo, Brazil, 18618-970.
Cochrane Database Syst Rev. 2016 Jan 12(1):CD010222. doi: 10.1002/14651858.CD010222.pub3.
Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.This review is an update of a Cochrane systematic review first published in 2014.
To assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.
The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched December 2015) and CENTRAL (2015, Issue 11). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched.
Randomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.
Two review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.
No studies were identified that met the inclusion criteria.
AUTHORS' CONCLUSIONS: There is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.
急性肺栓塞（PE）是常见的死亡原因，每年导致50000至200000人死亡。它是心血管疾病中第三大常见死因，仅次于冠状动脉疾病和中风。多排螺旋CT肺动脉造影（CTPA）的出现使得对肺栓塞的评估得到改善，能更好地显示外周肺动脉，提高了其诊断率。因此，更多外周肺栓塞病例被发现，如孤立性亚段肺栓塞（SSPE）和偶发性肺栓塞。这两种情况通常见于几乎没有或没有咯血、胸膜炎性疼痛、急性呼吸困难或循环衰竭等典型肺栓塞症状的患者。然而，心肺储备功能降低的患者出现孤立性SSPE时可能会有典型的肺栓塞症状。偶发性SSPE通常在无症状患者中偶然发现，通常是因其他原因进行诊断性影像学检查时发现的（例如肿瘤患者为癌症分期进行的常规CT检查）。传统上，所有肺栓塞患者无论血栓的部位、数量和大小，均采用相似的抗凝方式。有人提出，许多孤立性SSPE患者接受治疗可能并无益处，不必要地使用抗凝剂会增加不良事件的发生。与近端肺栓塞患者相比，孤立性SSPE或偶发性肺栓塞患者的临床表现可能更为良性。然而，必须研究此类患者的临床意义及其预后，以评估是否需要抗凝治疗。本综述是对2014年首次发表的Cochrane系统评价的更新。
评估抗凝治疗与不干预相比，对孤立性亚段肺栓塞（SSPE）或偶发性SSPE患者的有效性和安全性。
Cochrane血管试验检索协调员检索了专业注册库（最后检索时间为2015年12月）和CENTRAL（2015年第11期）。还检索了MEDLINE、EMBASE、LILACS和临床试验数据库。
对比抗凝治疗与不干预对SSPE或偶发性SSPE患者疗效的随机对照试验。
两位综述作者检查了所有文献，以确保选择可靠。我们计划让两位综述作者独立提取数据，并根据《Cochrane系统评价干预措施手册》推荐的标准评估纳入试验的方法学质量。
未发现符合纳入标准的研究。
对于孤立性亚段肺栓塞（SSPE）或偶发性SSPE患者，没有随机对照试验证据表明抗凝治疗与不干预相比的有效性和安全性，因此我们无法得出任何结论。在做出明智的临床决策之前，需要开展高质量的研究。
