Incomplete recovery of lung perfusion after 3 months in patients with acute pulmonary embolism treated with antithrombotic agents. THESEE Study Group. Tinzaparin ou Heparin Standard: Evaluation dans l'Embolie Pulmonaire Study.
We assessed the time course of lung perfusion after 3 mo of anticoagulant therapy for acute pulmonary embolism (APE) on the basis of perfusion lung scan (PLS) findings for 157 patients included in the Tinzaparin ou Heparin Standard: Evaluation dans l'Embolie Pulmonaire Study (THESEE), a multicenter, randomized, nonmasked trial comparing standard, continuous, adjusted-dose intravenous heparin with once-daily, subcutaneous, low-molecular-weight heparin in patients with APE.


METHODS
We calculated the percentage-of-vascular-obstruction score (PVOs) on PLSs on the day of diagnosis of APE (PVOsD1), on day 8 (PVOsD8), and after 3 mo (PVOsM3) and the mean relative changes in PVOs on day 8 versus the day of diagnosis and after 3 mo versus the day of diagnosis.


RESULTS
Mean PVOsD1 +/- SD was 49% +/- 20%, PVOsD8 was 29% +/- 18%, and PVOsM3 was 19% +/- 18%. PVOsD1 was at least 50% in 49% of patients. Reperfusion did not correlate with age, importance of initial obstruction, or clinical severity of disease at inclusion in THESEE. Relative change after 3 mo versus at diagnosis was lower in the 87 patients with associated prior cardiopulmonary disease than in those without. In the 43 patients with a history of thromboembolic disease, neither mean PVOsD1 nor the time course of PVOs was different from those in patients without a history of thromboembolic disease. Residual defects after 3 mo were observed in 104 patients (66%), including 13 with a PVOs of at least 50%.


CONCLUSIONS
These results emphasize the need for a control PLS at completion of anticoagulant therapy for APE, even in patients with full resolution of symptoms.
Wartski
M
M
Department of Nuclear Medicine, Marie Lannelongue Surgical Center, Le Plessis-Robinson, France.
Collignon
M A
MA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011877:Radionuclide Imaging; D013997:Time Factors; D000078222:Tinzaparin; D014692:Ventilation-Perfusion Ratio
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D006493:Heparin