Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Service de Pneumologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
J Thromb Haemost. 2017 Aug;15(8):1584-1590. doi: 10.1111/jth.13746. Epub 2017 Jul 17.
Essentials Safety of computed tomography (CTPA) to exclude pulmonary embolism (PE) in all patients is debated. We analysed the outcome of PE-likely outpatients left untreated after negative CTPA alone. The 3-month venous thromboembolic risk in these patients was very low (0.6%; 95% CI 0.2-2.3). Multidetector CTPA alone safely excludes PE in patients with likely clinical probability.
Background In patients with suspected pulmonary embolism (PE) classified as having a likely or high pretest clinical probability, the need to perform additional testing after a negative multidetector computed tomography pulmonary angiography (CTPA) finding remains a matter of debate. Objectives To assess the safety of excluding PE by CTPA without additional imaging in patients with a likely pretest probability of PE. Patients/Methods We retrospectively analyzed patients included in two multicenter management outcome studies that assessed diagnostic algorithms for PE diagnosis. Results Two thousand five hundred and twenty-two outpatients with suspected PE were available for analysis. Of these 2522 patients, 845 had a likely clinical probability as assessed by use of the simplified revised Geneva score. Of all of these patients, 314 had the diagnosis of PE excluded by a negative CTPA finding alone without additional testing, and were left without anticoagulant treatment and followed up for 3 months. Two patients presented with a venous thromboembolism (VTE) during follow-up. Therefore, the 3-month VTE risk in likely-probability patients after a negative CTPA finding alone was 2/314 (0.6%; 95% confidence interval [CI] 0.2-2.3%). Conclusions In outpatients with suspected PE and a likely clinical probability as assessed by use of the simplified revised Geneva score, CTPA alone seems to be able to safely exclude PE, with a low 3-month VTE rate, which is similar to the VTE rate following the gold standard, i.e. pulmonary angiography.
在疑似肺栓塞（PE）患者中，根据简化修订的日内瓦评分，临床可能性为很可能或高度，对于这些患者，在阴性多层螺旋 CT 肺动脉造影（CTPA）后是否需要进行额外的检查，目前仍存在争议。本研究旨在评估在临床可能性很可能的患者中，单纯 CTPA 排除 PE 的安全性。
我们回顾性分析了两项多中心管理结局研究中纳入的患者，这些研究评估了 PE 诊断的诊断算法。
共 2522 例疑似 PE 的门诊患者纳入分析。其中 845 例患者简化修订的日内瓦评分评估为很可能的临床可能性。在这些患者中，314 例患者的阴性 CTPA 结果排除了 PE，未进行额外检查，且未接受抗凝治疗，并随访 3 个月。2 例患者在随访期间出现静脉血栓栓塞（VTE）。因此，单纯阴性 CTPA 结果后很可能概率患者的 3 个月 VTE 风险为 2/314（0.6%；95%置信区间 [CI] 0.2-2.3%）。
在疑似 PE 且简化修订的日内瓦评分评估为很可能临床可能性的门诊患者中，单纯 CTPA 似乎能够安全地排除 PE，3 个月的 VTE 发生率较低，与金标准即肺动脉造影的 VTE 发生率相似。
