Meta-analysis: outcomes in patients with suspected pulmonary embolism managed with computed tomographic pulmonary angiography.
BACKGROUND
Spiral computed tomographic pulmonary angiography (CTPA) is increasingly being used in the evaluation of patients with clinically suspected pulmonary embolism (PE). However, CTPA as a definitive diagnostic test may be limited by inadequate sensitivity, especially in instances of isolated subsegmental emboli.


OBJECTIVE
To assess the safety of withholding anticoagulation in patients with suspected PE and negative results on CTPA.


METHODS
All relevant studies identified in MEDLINE (1966 to March 2004) and EMBASE (1974 to 2004) and in bibliographies of key articles. The search was not limited to the English language.


METHODS
The authors selected all published studies that used CTPA to evaluate suspected PE and reported at least 3 months of follow-up in patients not receiving anticoagulation on the basis of a negative CTPA result.


METHODS
Two reviewers independently rated study quality on the basis of predetermined criteria. Data were extracted on participants, CTPA technique, diagnostic studies performed, prevalence of PE, number of patients with negative or indeterminate CTPA results who were followed, and subsequent rates of venous thromboembolism and fatal PE.


RESULTS
Twenty-three studies reported on 4657 patients with negative CTPA results who did not receive anticoagulation. The 3-month rate of subsequent venous thromboembolic events was 1.4% (95% CI, 1.1% to 1.8%), and the 3-month rate of fatal PE was 0.51% (CI, 0.33% to 0.76%).


CONCLUSIONS
The CTPA technology used varied across studies and was not applied uniformly in the same step of diagnostic algorithms. Only 1 study used CTPA as the sole diagnostic test.


CONCLUSIONS
The rate of subsequent venous thromboembolism after negative results on CTPA is similar to that seen after negative results on conventional pulmonary angiography. It appears to be safe to withhold anticoagulation after negative CTPA results.
Moores
Lisa K
LK
Uniformed Services University of the Health Sciences, Walter Reed Army Medical Center, Washington, DC 20307, USA. Lisa.Moores@na.amedd.army.mil
Jackson
William L
WL
Shorr
Andrew F
AF
Jackson
Jeffrey L
JL
D000792:Angiography / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D028761:Withholding Treatment
D000925:Anticoagulants