Original ArticleOutcomes After Withholding Anticoagulation From Patients With Suspected Acute Pulmonary Embolism and Negative Computed Tomographic Findings: A Cohort Study
Section snippets
Study Setting and Design
Using the Mayo Clinic CT database, we identified all Mayo Clinic patients who were referred for electron beam CT because of clinical suspicion of acute pulmonary embolism over the 62-week period from August 7, 1997, to November 30, 1998. From dictated indications and diagnostic American College of Radiology codes, we identified all patients who underwent CT to “rule out acute pulmonary embolism.” We chose August 7, 1997, as our beginning date because at that time we consistently used 3-mm
RESULTS
A total of 1512 consecutive patients with clinically suspected acute pulmonary embolism were referred for CT between August 7, 1997, and November 30, 1998. In 1010 of these patients, the CT scan was interpreted as negative for acute pulmonary embolism. Seventeen patients were excluded because they received anticoagulation despite negative CT results; 8 received anticoagulation for acute deep venous thrombosis, and 9 received anticoagulation for other indications. Therefore, 993 patients were
DISCUSSION
Our results show that patients with suspected acute pulmonary embolism and negative CT results have an excellent outcome without anticoagulation. Symptomatic venous thromboembolism was rare within the 3 months after negative CT results, which exclude most clinically important pulmonary embolisms.
Our results confirm and extend the findings of other investigators. Among 109 patients with negative spiral CT results from whom anticoagulation was withheld, Ferretti et al40 found a 3-month cumulative
CONCLUSIONS
The 3-month incidence of (1) overall deep venous thrombosis or pulmonary embolism or (2) fatal pulmonary embolism is low among patients with suspected acute pulmonary embolism, negative CT results, and no other evidence of venous thromboembolism. Consequently, it is safe to withhold anticoagulation in such patients.
We believe that CT should replace the radionuclide lung scan as the initial diagnostic test of choice for suspected acute pulmonary embolism.48 Frequently, CT excludes pulmonary
REFERENCES (48)
- et al.
Anticoagulant drugs in the treatment of pulmonary embolism
Lancet
(1960) - et al.
Diagnostic value of ventilation-perfusion lung scanning in patients with suspected pulmonary embolism
Chest
(1985) - et al.
Prospective study of a standardized questionnaire to improve clinical estimate of pulmonary embolism
Chest
(1989) - et al.
Longterm follow-up of patients with suspected pulmonary embolism and a normal lung scan: perfusion scans in embolic suspects
Chest
(1982) - et al.
Clinical validity of a normal perfusion lung scan in patients with suspected pulmonary embolism
Chest
(1990) - et al.
Non-invasive diagnosis of venous thromboembolism in outpatients
Lancet
(1999) - et al.
A randomized trial of spiral CT and ventilation perfusion scintigraphy for the diagnosis of pulmonary embolism
Clin Radiol
(1998) - et al.
Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis
Chest
(1989) - et al.
Clinical outcomes of patients after a negative spiral CT pulmonary arteriogram in the evaluation of acute pulmonary embolism
J Vasc Interv Radiol
(1999) - et al.
The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism
Am J Med
(1981)
Continuing risk of thromboemboli among patients with normal pulmonary angiograms
Chest
Diagnosis of pulmonary embolism with use of computed tomographic angiography
Mayo Clin Proc
Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study
Arch Intern Med
Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study
Arch Intern Med
Mortality in patients treated for pulmonary embolism
JAMA
Risk of fatal pulmonary embolism in patients with treated venous thromboembolism
JAMA
Bleeding complications in oral anticoagulant therapy: an analysis of risk factors
Arch Intern Med
Diagnosing pulmonary embolism using clinical findings
Arch Intern Med
Use of a clinical model for safe management of patients with suspected pulmonary embolism
Ann Intern Med
Opinions regarding the diagnosis and management of venous thromboembolic disease
Chest
The incidence, etiologies, and avoidance of complications of pulmonary angiography in a large series
Radiology
Complications and validity of pulmonary angiography in acute pulmonary embolism
Circulation
Management of venous thromboembolism
N Engl J Med
Pulmonary embolism
N Engl J Med
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Funded in part by grants from the National Institutes of Health (HL60279), US Public Health Service, and by Mayo Foundation.