RESUMO
Diagnostic management of suspected pulmonary embolism (PE) in patients with a history of venous thromboembolism (VTE) is complicated due to persistent abnormal D-dimer levels, residual embolic obstruction and higher clinical prediction rule (CPR) scores. We aimed to evaluate the safety and efficiency of the standard diagnostic algorithm consisting of a CPR, D-dimer test and computed tomography pulmonary angiography (CTPA) in this specific patient category. We performed a systematic literature search for prospective studies evaluating a diagnostic algorithm in consecutive patients with clinically suspected PE and a history of VTE. The VTE incidence rates during three-month follow-up and the number of indicated CTPAs were pooled using random effect models. Four studies concerning 1,286 patients were included with a pooled baseline PE prevalence of 36 % (95 % confidence interval [CI] 30-42). In only 217 patients (15 %; 95 %CI 11-20) PE could be excluded without CTPA. The three-month VTE incidence rate was 0.8 % (95 %CI 0.06-2.4) in patients managed without CTPA, 1.6 % (95 %CI 0.3-4.0) in patients in whom PE was excluded by CTPA and 1.4 % (95 %CI 0.6-2.7) overall. In the pooled studies, PE was safely excluded in patients with a history of VTE based on a CPR followed by a D-dimer test and/or CTPA, although the efficiency of the algorithm is relatively low compared to patients without a history of VTE.
Assuntos
Angiografia , Produtos de Degradação da Fibrina e do Fibrinogênio/química , Embolia Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X , Tromboembolia Venosa/diagnóstico , Algoritmos , Cardiologia/normas , Técnicas de Apoio para a Decisão , Humanos , Incidência , Prevalência , Estudos Prospectivos , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Tromboembolia Venosa/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Doença de Chagas/epidemiologia , Trypanosoma cruzi/patogenicidade , Espanha/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Causas de Morte , Infecções por HIV/mortalidade , Antirretrovirais/uso terapêuticoRESUMO
No disponible
