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Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge.
Thromb Haemost. 2007 Jun; 97(6):944-8.TH

Abstract

It is unknown whether strategies validated for diagnosing pulmonary embolism (PE) are valid in patients with a history of PE. It was the objective of this study to investigate whether a diagnostic algorithm consisting of sequential application of a clinical decision rule (CDR), a quantitative D-dimer test and computed tomography (CT) safely ruled out a clinical suspicion of acute recurrent PE. Data were obtained from a diagnostic outcome study of patients suspected of PE. Acute recurrent PE was ruled out by an unlikely probability of PE (CDR score </= 4 points) combined with a normal D-dimer test (</= 500 ng/ml) or by a normal CT in all other patients. The primary outcome was the incidence of acute recurrent venous thromboembolism during three months of follow-up in patients with normal tests and not treated with anticoagulants. Of 3,306 patients suspected of acute PE, 259 patients (7.8%) had a history of PE of whom 234 were not treated with anticoagulants. The probability of PE was unlikely in 82 of 234 patients (35%), and 42 had a normal D-dimer test (18%), excluding recurrent PE. None of these patients had a thrombotic event during follow-up (0%, 95%CI: 0-6.9). A CT was indicated in all other patients (192) and ruled out recurrent PE in 127 patients (54%). Only one patient with a negative CT had a fatal recurrent PE during follow-up (0.8%; 95%CI: 0.02-4.3). In conclusion, this prospective study demonstrates the safety of ruling out a clinical suspicion of acute recurrent PE by a simple diagnostic algorithm in patients with a history of PE.

Authors+Show Affiliations

Department of General Internal Medicine- Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. M.Nijkeuter@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

17549296

Citation

Nijkeuter, Mathilde, et al. "Clinically Suspected Acute Recurrent Pulmonary Embolism: a Diagnostic Challenge." Thrombosis and Haemostasis, vol. 97, no. 6, 2007, pp. 944-8.
Nijkeuter M, Kwakkel-van Erp H, Söhne M, et al. Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge. Thromb Haemost. 2007;97(6):944-8.
Nijkeuter, M., Kwakkel-van Erp, H., Söhne, M., Tick, L. W., Kruip, M. J., Ullmann, E. F., Kramer, M. H., Büller, H. R., Prins, M. H., Leebeek, F. W., & Huisman, M. V. (2007). Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge. Thrombosis and Haemostasis, 97(6), 944-8.
Nijkeuter M, et al. Clinically Suspected Acute Recurrent Pulmonary Embolism: a Diagnostic Challenge. Thromb Haemost. 2007;97(6):944-8. PubMed PMID: 17549296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinically suspected acute recurrent pulmonary embolism: a diagnostic challenge. AU - Nijkeuter,Mathilde, AU - Kwakkel-van Erp,Hanneke, AU - Söhne,Maaike, AU - Tick,Lidwine W, AU - Kruip,Marieke J H A, AU - Ullmann,Eric F, AU - Kramer,Mark H H, AU - Büller,Harry R, AU - Prins,Martin H, AU - Leebeek,Frank W G, AU - Huisman,Menno V, AU - ,, PY - 2007/6/6/pubmed PY - 2007/8/19/medline PY - 2007/6/6/entrez SP - 944 EP - 8 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 97 IS - 6 N2 - It is unknown whether strategies validated for diagnosing pulmonary embolism (PE) are valid in patients with a history of PE. It was the objective of this study to investigate whether a diagnostic algorithm consisting of sequential application of a clinical decision rule (CDR), a quantitative D-dimer test and computed tomography (CT) safely ruled out a clinical suspicion of acute recurrent PE. Data were obtained from a diagnostic outcome study of patients suspected of PE. Acute recurrent PE was ruled out by an unlikely probability of PE (CDR score </= 4 points) combined with a normal D-dimer test (</= 500 ng/ml) or by a normal CT in all other patients. The primary outcome was the incidence of acute recurrent venous thromboembolism during three months of follow-up in patients with normal tests and not treated with anticoagulants. Of 3,306 patients suspected of acute PE, 259 patients (7.8%) had a history of PE of whom 234 were not treated with anticoagulants. The probability of PE was unlikely in 82 of 234 patients (35%), and 42 had a normal D-dimer test (18%), excluding recurrent PE. None of these patients had a thrombotic event during follow-up (0%, 95%CI: 0-6.9). A CT was indicated in all other patients (192) and ruled out recurrent PE in 127 patients (54%). Only one patient with a negative CT had a fatal recurrent PE during follow-up (0.8%; 95%CI: 0.02-4.3). In conclusion, this prospective study demonstrates the safety of ruling out a clinical suspicion of acute recurrent PE by a simple diagnostic algorithm in patients with a history of PE. SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/17549296/Clinically_suspected_acute_recurrent_pulmonary_embolism:_a_diagnostic_challenge_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=17549296.ui DB - PRIME DP - Unbound Medicine ER -