Thromb Haemost 2015; 114(01): 26-34
DOI: 10.1160/TH14-10-0842
Coagulation and Fibrinolysis
Schattauer GmbH

Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism

Paul L. den Exter*
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Josien van Es*
2   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Lucia J. M. Kroft
3   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
,
Petra M. G. Erkens
4   Department of Clinical Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, the Netherlands
,
Renée A. Douma
2   Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
,
Inge C. M. Mos
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
Gé Jonkers
5   Department of Internal Medicine, Rijnland Hospital, Leiderdorp, the Netherlands
,
Marcel M. C. Hovens
6   Department of internal medicine, Rijnstate Hospital, Arnhem, the Netherlands
,
Marc F. Durian
7   Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
,
Hugo ten Cate
8   Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
,
Ludo F. M. Beenen
9   Department of Radiology; Academic Medical Center, Amsterdam, the Netherlands
,
Pieter Willem Kamphuisen
10   Department of Vascular Medicine, University Medical Center Groningen, Groningen, the Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
,
for the Prometheus Follow-Up Investigators › Author Affiliations
Further Information

Publication History

Received: 10 October 2014

Accepted after major revision: 13 February 2015

Publication Date:
22 November 2017 (online)

Summary

The systematic assessment of residual thromboembolic obstruction after treatment for acute pulmonary embolism (PE) has been under-studied. This assessment is of potential clinical importance, should clinically suspected recurrent PE occur, or as tool for risk stratification of cardiopulmonary complications or recurrent venous thromboembolism (VTE). This study aimed to assess the rate of PE resolution and its implications for clinical outcome. In this prospective, multi-center cohort study, 157 patients with acute PE diagnosed by CT pulmonary angiography (CTPA) underwent follow-up CTPA-imaging after six months of anticoagulant treatment. Two expert thoracic radiologists independently assessed the presence of residual thromboembolic obstruction. The degree of obstruction at baseline and follow-up was calculated using the Qanadli obstruction index. All patients were followed-up for 2.5 years. At baseline, the median obstruction index was 27.5 %. After six months of treatment, complete PE resolution had occurred in 84.1 % of the patients (95 % confidence interval (CI): 77.4–89.4 %). The median obstruction index of the 25 patients with residual thrombotic obstruction was 5.0 %. During follow-up, 16 (10.2 %) patients experienced recurrent VTE. The presence of residual thromboembolic obstruction was not associated with recurrent VTE (adjusted hazard ratio: 0.92; 95 % CI: 0.2–4.1). This study indicates that the incidence of residual thrombotic obstruction following treatment for PE is considerably lower than currently anticipated. These findings, combined with the absence of a correlation between residual thrombotic obstruction and recurrent VTE, do not support the routine use of follow-up CTPA-imaging in patients treated for acute PE.

* These authors contributed equally.


 
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