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Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study.

Publication ,  Journal Article
Subramaniam, RM; Blair, D; Gilbert, K; Coltman, G; Sleigh, J; Karalus, N
Published in: Intern Med J
September 2007

BACKGROUND: Accurate diagnosis of pulmonary embolism (PE) is essential and it is not clear whether a computed tomography pulmonary angiogram (CTPA) could be used as a stand-alone imaging investigation. The aim of the study was to test the accuracy of the clinical outcome of a negative CTPA as a stand-alone imaging investigation to exclude PE. METHODS: Five hundred and thirty-four consecutive patients who had a CTPA for diagnosis or exclusion of PE were recruited from March 2003 to October 2004. Four hundred and ninety-four patients had a helical CTPA as a stand-alone imaging investigation for diagnosis or exclusion of PE. A 3-month post-CTPA follow up was carried out in all patients to establish the clinical outcome accuracy of a negative CTPA as a stand-alone imaging investigation. RESULTS: There were 387 (78.3%) negative and 107 (21.7%) positive CTPA examinations. The average age of the patients was 57.16 years (standard deviation 18.57). Among those with a negative CTPA who survived, one patient had deep vein thrombosis and 342 patients had no evidence of an episode of venous thromboembolism or PE at the 3-month follow up. Thirty-eight patients died within the 3-month follow-up period and one patient's death was attributed to suspected PE. The negative predictive value of a CTPA is 99.5% (95% confidence interval 98.1-99.9%). CONCLUSION: Helical negative CTPA examination excludes clinically significant PE as a stand-alone imaging investigation. Where concurrent deep vein thrombosis is suspected, lower limb needs to be imaged by ultrasound if the CTPA is negative.

Duke Scholars

Published In

Intern Med J

DOI

EISSN

1445-5994

Publication Date

September 2007

Volume

37

Issue

9

Start / End Page

624 / 630

Location

Australia

Related Subject Headings

  • Withholding Treatment
  • Tomography, X-Ray Computed
  • Pulmonary Embolism
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Follow-Up Studies
  • Female
 

Citation

APA
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ICMJE
MLA
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Subramaniam, R. M., Blair, D., Gilbert, K., Coltman, G., Sleigh, J., & Karalus, N. (2007). Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study. Intern Med J, 37(9), 624–630. https://doi.org/10.1111/j.1445-5994.2007.01387.x
Subramaniam, R. M., D. Blair, K. Gilbert, G. Coltman, J. Sleigh, and N. Karalus. “Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study.Intern Med J 37, no. 9 (September 2007): 624–30. https://doi.org/10.1111/j.1445-5994.2007.01387.x.
Subramaniam RM, Blair D, Gilbert K, Coltman G, Sleigh J, Karalus N. Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study. Intern Med J. 2007 Sep;37(9):624–30.
Subramaniam, R. M., et al. “Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study.Intern Med J, vol. 37, no. 9, Sept. 2007, pp. 624–30. Pubmed, doi:10.1111/j.1445-5994.2007.01387.x.
Subramaniam RM, Blair D, Gilbert K, Coltman G, Sleigh J, Karalus N. Withholding anticoagulation after a negative computed tomography pulmonary angiogram as a stand-alone imaging investigation: a prospective management study. Intern Med J. 2007 Sep;37(9):624–630.
Journal cover image

Published In

Intern Med J

DOI

EISSN

1445-5994

Publication Date

September 2007

Volume

37

Issue

9

Start / End Page

624 / 630

Location

Australia

Related Subject Headings

  • Withholding Treatment
  • Tomography, X-Ray Computed
  • Pulmonary Embolism
  • Prospective Studies
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Follow-Up Studies
  • Female