Systematic review and meta-analysis of outcomes in patients with suspected pulmonary embolism

Parth Patel, Payal Patel, Meha Bhatt, Cody Braun, Housne Begum, Robby Nieuwlaat, Rasha Khatib, Carolina C. Martins, Yuan Zhang, Itziar Etxeandia-Ikobaltzeta, Jamie Varghese, Hani Alturkmani, Waled Bahaj, Mariam Baig, Rohan Kehar, Ahmad Mustafa, Rakesh Ponnapureddy, Anchal Sethi, Merrill Thomas, David WooldridgeWendy Lim, Shannon M. Bates, Eddy Lang, Grégoire Le Gal, Linda B. Haramati, Jeffrey Kline, Marc Righini, Wojtek Wiercioch, Holger Schünemann, Reem A. Mustafa

Research output: Contribution to journalReview articlepeer-review

Abstract

Prompt evaluation and therapeutic intervention of suspected pulmonary embolism (PE) are of paramount importance for improvement in outcomes. We systematically reviewed outcomes in patients with suspected PE, including mortality, incidence of recurrent PE, major bleeding, intracranial hemorrhage, and postthrombotic sequelae. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. We included 22 studies with 15 865 patients. Among patients who were diagnosed with PE and discharged with anticoagulation, 3-month follow-up revealed that all-cause mortality was 5.69% (91/1599; 95% confidence interval [CI], 4.56-6.83), mortality from PE was 1.19% (19/1597; 95% CI, 0.66-1.72), recurrent venous thromboembolism (VTE) occurred in 1.38% (22/1597; 95% CI: 0.81-1.95), and major bleeding occurred in 0.90% (2/221%; 95% CI, 0-2.15). In patients with a low pretest probability (PTP) and negative D-dimer, 3-month follow-up revealed mortality from PE was 0% (0/808) and incidence of VTE was 0.37% (4/1094; 95% CI: 0.007-0.72). In patients with intermediate PTP and negative D-dimer, 3-month follow-up revealed that mortality from PE was 0% (0/2747) and incidence of VTE was 0.46% (14/3015; 95% CI: 0.22-0.71). In patients with high PTP and negative computed tomography (CT) scan, 3-month follow-up revealed mortality from PE was 0% (0/651) and incidence of VTE was 0.84% (11/1302; 95% CI: 0.35-1.34). We further summarize outcomes evaluated by various diagnostic tests and diagnostic pathways (ie, D-dimer followed by CT scan).

Original languageEnglish (US)
Pages (from-to)2237-2244
Number of pages8
JournalBlood Advances
Volume5
Issue number8
DOIs
StatePublished - Apr 27 2021

ASJC Scopus subject areas

  • Hematology

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