Chest
Special FeaturesResolution of Thromboemboli in Patients With Acute Pulmonary Embolism: A Systematic Review
Section snippets
Search Strategy
We used electronic search strategies to identify relevant studies. The following electronic databases were searched: PubMed (1966 to November 2004), EMBASE (1980 to November 2004), Cochrane, the Library Issue 1, 2005, and Web of Science using the following search terms: residual thrombosis or incomplete recovery or incomplete resolution or (resolving AND [clots OR clot]) or ([normalization OR normalization] AND [pulmonary arteries OR pulmonary artery]) or ([(thrombi AND regression) or thrombus
Results
We identified 29 clinical studies. Of these, 25 studies were excluded for the following reasons: (1) retrospective design789101112131415; (2) nonconsecutive patients7101112131617181920212223242526272829; (3) lack of objective verification of the diagnosis1017182130; (4) asymptomatic patients25; (5) treatment with inferior vena cava ligation or femoral ligation, embolectomy, or no treatment in some patients789101116181920212324252931; (6) anticoagulant therapy for < 6 weeks10182324; and (7) no
Studies Using V/Q Scintigraphy at Follow-up
Hvid-Jacobsen et al32 re-examined 30 consecutive patients 6 months after diagnosis of PE. All patients were available for follow-up. All underwent repeat V/Q scans and chest radiographs, and all had been treated for 3 months. Six months after diagnosis, 13 patients (43%) had normalized scan findings, 9 patients (30%) had minor defects, 6 patients (20%) had persistent defects, and 2 patients had new defects. None of the patients had symptoms of recurrent PE. In this early study,32 the authors
Studies Using Helical CT at Follow-up
Remy-Jardin et al34 were among the first to use helical CT as a follow-up test to evaluate the resolution of acute PE. Of 111 eligible patients referred to an ICU with massive acute PE, 49 patients did not undergo follow-up evaluation for the following reasons: the patient died during follow-up (22 patients), the patient had a history of (extra-)thoracic malignancy and a poor clinical status (10 patients), the patient was > 85 years old (7 patients), the patient had a history of allergic
Discussion
This review shows that complete resolution of pulmonary thromboembolism is not routinely achieved between 8 days and 11 months after acute PE. Overall, > 50% of patients with PE have persistent defects at their follow-up scan 6 months after diagnosis (Fig 1). Afterward, resolution of thrombi seems to reach a plateau phase, since complete resolution is found in 43% of patients after 6 months and in nearly the same percentage of patients (48%) after 11 months. Of interest is the wide variation in
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