Département de Médecine Nucléaire, Centre Hospitalier Universitaire de Brest, Brest, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada.
J Thromb Haemost. 2023 Jun;21(6):1519-1528.e2. doi: 10.1016/j.jtha.2023.01.030. Epub 2023 Feb 3.
We aimed to assess the relationship between residual pulmonary vascular obstruction (RPVO) on planar lung scan after completion of at least 3 months of anticoagulant therapy for acute pulmonary embolism (PE) and the risk of recurrent venous thromboembolism (VTE) or death due to PE one year after treatment discontinuation. The systematic review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO: CRD42017081080). The primary outcome measure was to generate a pooled estimate of the rate of recurrent VTE at one year in patient with RPVO diagnosed on planar lung scan after discontinuation of at least 3 months of anticoagulant treatment for an acute PE. Individual data were obtained for 809 patients. RPVO (ie, obstruction >0%) was found in 407 patients (50.3%) after a median of 6.6 months of anticoagulant therapy for a first acute PE. Recurrent VTE or death due to PE occurred in 114 patients (14.1%), for an annual risk of 6.4% (95% confidence interval, 4.7%-8.6%). Out of the 114 recurrent events, 63 occurred within one year after discontinuation of anticoagulant therapy corresponding to a risk of 8.1% (6.4%-9.8%) at 1 year. The risk of recurrent VTE at one year was 5.8% (4.4-7.2) in participants with RPVO <5%, vs 11.7% (9.5-13.8) in participants with RPVO ≥5%. RPVO is a significant predictor of the risk of recurrent venous thromboembolism. However, the risk of recurrent events remains too high in patients without residual perfusion defect for it to be used as a stand-alone test to decide on anticoagulation discontinuation.
我们旨在评估急性肺栓塞（PE）患者完成至少 3 个月抗凝治疗后，平面肺扫描显示残留肺血管阻塞（RPVO）与停药 1 年后静脉血栓栓塞（VTE）复发或因 PE 死亡的风险之间的关系。系统评价已在国际前瞻性系统评价注册库（PROSPERO：CRD42017081080）中注册。主要结局测量指标是生成在停止急性 PE 至少 3 个月抗凝治疗后，平面肺扫描诊断为 RPVO 的患者在 1 年内 VTE 复发率的汇总估计值。我们获得了 809 名患者的个体数据。在首次急性 PE 接受抗凝治疗 6.6 个月后，407 名患者（50.3%）发现 RPVO（即，阻塞>0%）。114 名患者（14.1%）发生 VTE 复发或因 PE 死亡，年风险为 6.4%（95%置信区间，4.7%-8.6%）。在 114 例复发性事件中，有 63 例发生在停止抗凝治疗后 1 年内，对应于停药后 1 年时 8.1%（6.4%-9.8%）的风险。RPVO <5%的患者 1 年内 VTE 复发风险为 5.8%（4.4%-7.2），而 RPVO ≥5%的患者为 11.7%（9.5%-13.8%）。RPVO 是 VTE 复发风险的重要预测因素。然而，对于没有残留灌注缺陷的患者，复发事件的风险仍然很高，因此不能将其作为单独的检测方法来决定是否停止抗凝治疗。
