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Clot resolution after 3 weeks of anticoagulant treatment for pulmonary embolism: comparison of computed tomography and perfusion scintigraphy
Author(s) -
Es J.,
Douma R. A.,
Kamphuisen P. W.,
Gerdes V. E. A.,
Verhamme P.,
Wells P. S.,
Bounameaux H.,
Lensing A. W. A.,
Büller H. R.
Publication year - 2013
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12150
Subject(s) - medicine , pulmonary embolism , nuclear medicine , rivaroxaban , scintigraphy , pulmonary angiography , radiology , high resolution computed tomography , computed tomography , warfarin , atrial fibrillation
Summary Introduction Little is known about the natural history of clot resolution in the initial weeks of anticoagulant therapy in patients with acute pulmonary embolism ( PE ). Clot resolution of acute PE was assessed with either computed tomography pulmonary angiography scan ( CT ‐scan) or perfusion scintigraphy scan ( Q ‐scan) after 3 weeks of treatment. Methods This was a predefined safety analysis of the E instein PE study, including PE patients, randomized to either enoxaparin with vitamin K antagonist (VKA) or rivaroxaban. A similar scan as at baseline was repeated after 3 weeks. The percentage of vascular obstruction ( PVO ) was calculated on the basis of a weighted semiquantitative estimation of obstruction. Clot resolution was assessed blindly by calculating the relative change after 3 weeks. Results PE was diagnosed in 264 patients with CT ‐scan and in 83 with Q‐scan. Baseline characteristics were similar. At baseline, the mean PVO assessed with CT ‐scan ( PVO ‐ CT ) and the mean PVO assessed with Q ‐scan ( PVO ‐ Q ) were both 21% (standard deviation [ SD ] 13%) ( P = 0.9). The mean relative decrease in PVO was 71% ( SD 33%) for PVO ‐ CT , and 62% ( SD 36%) for PVO ‐ Q ( P = 0.02); complete resolution was observed in 44% (116/264; 95% confidence interval [ CI ] 38–50%) and 31% (26/83; 95% CI 22–42%) with CT ‐scan and Q ‐scan, respectively ( P = 0.04). No difference in clot resolution between enoxaparin/ VKA and rivaroxaban was found. Conclusion In patients with acute PE , only 3 weeks of anticoagulant treatment leads to complete clot resolution in a considerable proportion of patients, and normalization is more often observed with CT ‐scan than with Q ‐scan.