Diagnosis of Pulmonary Embolism in Patients with Proximal Deep Vein Thrombosis
| Autor: | Marielle Decousus, Florence Parent, Philippe Hervé, Andrea Buchmuller, Philippe Girard, Christian Lamer, Silvy Laporte, Bernard Tardy |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Vena Cava Filters medicine.drug_class Injections Subcutaneous Deep vein Administration Oral Pulmonary Artery Critical Care and Intensive Care Medicine Scintigraphy Sensitivity and Specificity Risk Factors Prevalence Pulmonary angiography medicine Humans Prospective Studies Enoxaparin Radionuclide Imaging Aged Aged 80 and over Venous Thrombosis medicine.diagnostic_test Heparin business.industry Anticoagulant Respiratory disease Angiography Anticoagulants Phlebography Middle Aged medicine.disease Thrombosis Pulmonary embolism medicine.anatomical_structure Injections Intravenous Radiology Pulmonary Embolism business |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 164:1033-1037 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/ajrccm.164.6.2101045 |
| Popis: | To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy. |
| Databáze: | OpenAIRE |
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