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A NONINVASIVE STRATEGY FOR SUSPECTED PULMONARY EMBOLISM.

Researchers from McMaster Hospital in Canada are responsible for much of our knowledge about diagnostic and therapeutic strategies for managing patients with suspected pulmonary embolism (PE). Of particular interest in this new study are the results of a noninvasive approach to patients whose lung scans demonstrate non-high-probability abnormalities (e.g., subsegmental matched ventilation- perfusion defects).

Of an initial cohort of 874 patients with suspected PE and adequate cardiorespiratory reserve, 414 had non-high- probability lung scans and underwent a maximum of five serial impedance plethysmographic (IPG) studies over a two- week period. Forty-three of the patients who underwent IPG were found to have proximal vein thrombosis and were anticoagulated, leaving 371 IPG-negative patients who were followed without treatment. Ten (2.7 percent) of these 371 patients developed venous thromboembolism in the ensuing three months. However, only one (who underwent major surgery for cancer during the follow-up period) died of PE.

These results suggest that pulmonary angiography and anticoagulation can be safely withheld in most patients with indeterminate lung scans and serially negative noninvasive tests for proximal leg thrombosis. Although a few of these patients will eventually develop detectable venous thrombosis, clinically important PE is unlikely to occur.

— ASB

Published in Journal Watch General Medicine December 1, 1989

Citation(s):

Hull RD et al. A new noninvasive management strategy for patients with suspected pulmonary embolism. Arch Intern Med 1989 Nov 149 2549-2555.

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