Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
Internal Medicine, Hospital Universitari Bellvitge-IDIBELL, Barcelona, Spain.
J Thromb Haemost. 2019 Aug;17(8):1217-1228. doi: 10.1111/jth.14477. Epub 2019 Jun 4.
Essentials Debated is the role of residual pulmonary obstruction (RPO) in predicting venous thromboembolism. Whether right ventricular dysfunction (RVD) predicts recurrent venous thromboembolism is unknown. 15 studies on RPO and 4 on RVD and venous thromboembolism were included in this meta-analysis. RPO is a predictor of recurrent venous thromboembolism when assessed by perfusion lung scan. RVD after acute pulmonary embolism is not associated with recurrent venous thromboembolism.
There is conflicting evidence regarding the role of residual pulmonary obstruction (RPO) or persistent right ventricular dysfunction (RVD) after pulmonary embolism (PE) as a predictor of recurrent venous thromboembolism (VTE). The aim of this study was to assess whether RPO or persistent RVD after PE is associated with recurrent VTE.
MEDLINE and EMBASE were searched through December 2018. Studies reporting on (a) RPO either on computed tomography (CT) angiography or perfusion lung scan, or RVD on echocardiography or CT angiography, after therapeutic anticoagulation for the acute PE, and (b) recurrent VTE, were included in this meta-analysis.
RPO was associated with an increased risk of recurrent VTE (16 studies; 3472 patients; odds ratio [OR] 2.22; 95% confidence interval [CI] 1.61-3.05; I = 26%); the association was statistically significant for lung scan-detected RPO (11 studies; 2916 patients; OR 2.21; 95% CI 1.63-3.01) but not for CT angiography-detected RPO (five studies; 556 patients; OR 2.56; 95% CI 0.82-7.94). No significant association was found between persistent RVD and recurrent VTE (four studies; 852 patients; OR 1.62; 95% CI 0.63-4.17).
RPO is a predictor of recurrent VTE after a first acute PE, mainly when assessed by perfusion lung scan.
探讨残余肺阻塞（RPO）在预测静脉血栓栓塞（VTE）中的作用。尚不清楚右心室功能障碍（RVD）是否预测复发性 VTE。本荟萃分析纳入了 15 项关于 RPO 和 4 项关于 RVD 和 VTE 的研究。通过灌注肺扫描评估，RPO 是复发性 VTE 的预测因子。急性肺栓塞后 RVD 与复发性 VTE 无关。
关于残余肺阻塞（RPO）或急性肺栓塞（PE）后持续性右心室功能障碍（RVD）作为静脉血栓栓塞（VTE）复发的预测因子，目前证据相互矛盾。本研究旨在评估 PE 后 RPO 或持续性 RVD 是否与 VTE 复发相关。
通过 MEDLINE 和 EMBASE 检索至 2018 年 12 月。纳入研究：（a）经抗凝治疗后 CT 血管造影或灌注肺扫描检测到 RPO，或经超声心动图或 CT 血管造影检测到 RVD；（b）报道了复发性 VTE 的研究。
RPO 与复发性 VTE 的风险增加相关（16 项研究；3472 例患者；比值比 [OR] 2.22；95%置信区间 [CI] 1.61-3.05；I ² = 26%）；肺扫描检测到的 RPO （11 项研究；2916 例患者；OR 2.21；95%CI 1.63-3.01）与统计学显著相关，但 CT 血管造影检测到的 RPO 无显著相关性（5 项研究；556 例患者；OR 2.56；95%CI 0.82-7.94）。持续性 RVD 与复发性 VTE 之间无显著相关性（4 项研究；852 例患者；OR 1.62；95%CI 0.63-4.17）。
PE 后 RPO 是 VTE 复发的预测因子，主要通过灌注肺扫描评估。
