Safety of withholding anticoagulant therapy in patients with suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography.
BACKGROUND
To assess the safety of withholding anticoagulant therapy in patients with clinically suspected pulmonary embolism with a negative multislice computed tomography pulmonary angiography (MCTPA).


METHODS
Three hundred and eighty six patients who were consecutively assessed in the emergency room of our institution for suspected pulmonary embolism were eligible for our study. Patients with either a low or an intermediate clinical probability of pulmonary embolism according to the Wells score and a negative MCTPA for pulmonary embolism were enrolled. Patients with anticoagulant therapy for other medical conditions were excluded from this study. We assessed the percentage of patients in whom venous thromboembolic events or death related to this condition within three months after the negative CT.


RESULTS
Two hundred and forty two patients were included in our series [mean age+/-standard deviation (SD) (63.1+/-18.1)]. Only one patient (0.41% [95% confidence interval -0.4%-1.22%]) showed a non-fatal pulmonary embolism during the three-month follow-up period after an initial negative CT scan (negative predictive value, 99.58%). Eleven patients died during the follow-up period due to conditions unrelated to venous thromboembolic disease (pneumonia [n=5], lung cancer [n=2], wasting syndrome [n=1], acute myocardial infarction [n=1], leiomyosarcoma [n=1], and severe pulmonary hypertension [n=1]).


CONCLUSIONS
Withholding anticoagulant therapy in patients with suspected venous thromboembolic disease with a negative result on MCTPA seems to be safe in our clinical setting.
Galipienzo
Javier
J
Servicio de Urgencias, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain. javiergalipienzogarcia@yahoo.es
García de Tena
Jaime
J
Flores
Julio
J
Alvarez
Concepción
C
Alonso-Viteri
Soledad
S
Ruiz
Antonio
A
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000209:etiology
D000925:Anticoagulants