Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism. A single center cohort study

Risk factors for recurrent venous thromboembolism after unprovoked pulmonary embolism: the PADIS-PE randomised trial

“…One of the most striking findings is the observation, in the main and all secondary multivariate analyses (supplementary table S2), of a strong and independent impact of PVOI, either at 6 months of anticoagulation or at diagnosis of pulmonary embolism, on the risk of recurrent VTE. Consistent with previous prospective or retrospective studies where PVOI after the first months of anticoagulation was assessed using V/Q lung scan, we found that residual pulmonary vascular obstruction was present in about one-third of patients and was associated with an increased risk of recurrent VTE [17,[27][28][29][30][31]. In our study, ROC curve analysis yielded a 5% PVOI threshold, which was lower than in previous studies and whose reproducibility might be questionable [17,27]; however, a 5% perfusion defect on V/Q lung scan represents one segmental perfusion defect that is clinically relevant in the setting of suspected pulmonary embolism [32].…”

“…Consistent with previous prospective or retrospective studies where PVOI after the first months of anticoagulation was assessed using V/Q lung scan, we found that residual pulmonary vascular obstruction was present in about one-third of patients and was associated with an increased risk of recurrent VTE [17,[27][28][29][30][31]. In our study, ROC curve analysis yielded a 5% PVOI threshold, which was lower than in previous studies and whose reproducibility might be questionable [17,27]; however, a 5% perfusion defect on V/Q lung scan represents one segmental perfusion defect that is clinically relevant in the setting of suspected pulmonary embolism [32]. In studies that assessed residual pulmonary vascular obstruction using CTPA, no association between this parameter and the risk of recurrent VTE was observed [33,34]; however, it has been shown that the accuracy of CTPA to detect residual pulmonary vascular obstruction is inferior to that of V/Q lung scan [34].…”

“…At pulmonary embolism diagnosis, consistent with others, mean PVOI was [28,30]. In the only prospective trial that assessed the impact of this parameter on the risk of recurrent VTE after stopping anticoagulation, no association was observed between PVOI ⩾10% at pulmonary embolism diagnosis (cut-off based on clinical relevance) and the risk of recurrent VTE [17]. In our study, ROC curve analysis yielded a 40% threshold PVOI value at diagnosis to predict a high risk of recurrent VTE, which is close to that observed in prospective trials that evaluated PVOI at pulmonary embolism diagnosis on the risk of death [35,36] or early recurrent VTE during anticoagulation [37].…”

“…As a consequence, identifying risk factors of recurrent VTE remains a major issue in order to select low-risk groups in whom anticoagulation should not be extended and high-risk patients who require indefinite anticoagulation [8]. Several clinical, biochemical or morphological predictors of recurrence have been identified; however, for most of them, the strength of the association with recurrent VTE and their clinical impact were moderate or uncertain [3,5,[9][10][11][12][13][14][15][16][17]. Such an issue is of particular importance when unprovoked VTE initially occurred as unprovoked pulmonary embolism because there is evidence that these patients will more likely develop recurrence as a new pulmonary embolism (i.e.…”

Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta‐analysis

“…Overall, 538 papers were found, of which 16 met the inclusion criteria (the flow diagram is shown in Figure S1). In one study, the numbers of patients with or without RPO who had recurrent VTE events were obtained after the authors had been contacted . The agreement between reviewers for study selection was good (kappa statistic of 0.85).…”