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Investigation of the need for computed tomography pulmonary angiography in the decision to discontinue treatment for pulmonary thromboembolism

      Highlights

      • When discontinuing treatment in PTE, the evaluation of symptoms, D-dimer level, echocardiography (ECHO), and bilateral lower extremity color Doppler ultrasound (US) findings can help identify patients who should be considered at risk of recurrence.
      • Guidelines recommend computed tomography pulmonary angiography (CTPA) when discontinuing treatment in symptomatic patients. However, some patients with no clinical symptoms have positive imaging results. This is important for the evaluation of chronic thromboembolism.
      • We believe that evaluation with CTPA at treatment discontinuation is necessary in patients with elevated D-dimer, mPAP on ECHO above 40 mmHg, and especially high PAOI at diagnosis.

      Abstract

      Background

      Acute pulmonary thromboembolism (PTE) is an important cause of morbidity and mortality that can reduce quality of life due to long-term complications during and after treatment discontinuation.

      Objectives

      The aim of this study was to evaluate patients for these complications before discontinuing treatment and determine the necessity of computed tomography pulmonary angiography (CTPA) imaging.

      Methods

      This retrospective study included 116 patients over the age of 18 who received anticoagulant treatment for at least 3 months and presented for treatment discontinuation to the Atatürk University Research Hospital Chest Diseases Outpatient Clinic between January 2015 and September 2019.

      Results

      CTPA performed at treatment discontinuation showed complete thrombus resolution with treatment in 73 patients (62.9%). High pulmonary artery obstruction index (PAOI) at diagnosis was statistically associated with findings of residual or chronic thrombus on CTPA at treatment discontinuation (p = 0.001). In the differentiation of patients with residual/chronic thrombus and those with thrombus resolution, D-dimer at a cut-off value of 474 µg/L had 60% sensitivity and 70% specificity. At a cut-off value of 35.5 mmHg, mean pulmonary artery pressure on echocardiography had sensitivity and specificity of 72% and 77%, respectively. At a cut-off of 23.75, PAOI had sensitivity and specificity of 93% and 69%, respectively.

      Conclusion

      In addition to physical examination findings, D-dimer and echocardiography were guiding parameters in the evaluation of treatment discontinuation and thrombus resolution in patients presenting to the outpatient clinic for discontinuation of treatment for acute PTE. PAOI at diagnosis may be another important guiding parameter in addition to these examinations.

      Keywords

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