Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism - A critical review
Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism - A critical review
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DOI：
10.1053/crad.2001.0778
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发表时间：
2001-10-01
影响因子：
2.6
通讯作者：
Oudkerk, M
中科院分区：
文献类型：
--
作者：
van Beek, EJR;Brouwers, EMJ;Oudkerk, M
目的：根据肺血管造影正常患者停止抗凝治疗的安全性，确定肺血管造影正常排除肺栓塞（PE）的有效性。 材料和方法：对 1965 年至 1999 年 4 月发表的英文报告进行回顾。符合条件的文章描述了对疑似肺栓塞且肺血管造影正常的患者进行的前瞻性研究，这些患者未经治疗并随访了至少 3 个月。文章由两位作者使用预先定义的设计强度标准进行评估。终点包括致命和非致命的复发性血栓栓塞事件。通过从总体结果中一次删除一项研究并比较 1990 年前和 1990 年后的出版物，进行了敏感性分析。 结果：在分析中纳入的 8 篇文章中的 1050 名患者中，有 18 名患者描述了复发性血栓栓塞事件（1.7% 95% CI：1.0-2.7%）。其中三名患者死亡（0.3% 95% CI：0.02-0.7%）。 PE 的复发率从 1990 年之前的 2.9%（95% CI：1.4-6.8%）下降到 1990 年之后的 1.1%（95% CI：0.5-2.2%）。结论：PE 复发率表明，多年来通过血管造影排除 PE 的能力似乎有所提高。 PE 的低复发率支持正常肺血管造影排除 PE 的有效性。 (C) 2001 年皇家放射科医生学院。
AIM: To determine the validity of a normal pulmonary angiogram in the exclusion of pulmonary embolism (PE), based on the safety of withholding anticoagulant therapy in patients with a normal pulmonary angiogram.MATERIALS AND METHODS: A review of English reports published between 1965 and April 1999 was carried out. Eligible articles described prospective studies in patients with suspected PE and a normal pulmonary angiogram, who remained untreated and were followed-up for a minimum of 3 months. Articles were evaluated by two authors, using pre-defined criteria for strength of design. End points consisted of fatal and non-fatal recurrent thromboembolic events. A sensitivity analysis was performed, by removing one study at a time from the overall results and by comparing pre- and post-1990 publications.RESULTS: Among 1050 patients in eight articles included in the analysis, recurrent thromboembolic events were described in 18 patients (1.7% 95% CI: 1.0-2.7%). These were fatal in three patients (0.3% 95% CI: 0.02-0.7%). The recurrence rate of PE decreased from 2.9% (95% CI: 1.4-6.8%) before 1990 to 1.1% (95% CI: 0.5-2.2%) after 1990.CONCLUSION: It would appear that the ability to exclude PE by angiography has improved over the years, as indicated by recurrence rate of PE. The low recurrence rate of PE supports the validity of a normal pulmonary angiogram for the exclusion of PE. (C) 2001 The Royal College of Radiologists.