Key result
In patients diagnosed with pulmonary embolism and discharged with anticoagulation, 3-month all-cause mortality was 5.69% (95% CI, 4.56-6.83) and recurrent VTE was 1.38%.
Why the study?
Prompt evaluation and therapeutic intervention of suspected pulmonary embolism are critical for improving outcomes, motivating a systematic review of patient outcomes across diagnostic pathways.
What are the clinical outcomes in patients evaluated for suspected pulmonary embolism across different diagnostic pathways?
Meta-Analysis (n=15,865)
What are the clinical outcomes in patients evaluated for suspected pulmonary embolism across different diagnostic pathways?
Patients with suspected PE who are ruled out by negative D-dimer or CT scan have very low rates of subsequent VTE and 0% PE-related mortality at 3 months, supporting current diagnostic algorithms.
Supports safe PE exclusion via D-dimer (low/intermediate PTP) or CT (high PTP); reinforces guideline diagnostic algorithms.
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).
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Patel et al. (2021) conducted a meta-analysis in suspected pulmonary embolism (n=15,865). Diagnostic evaluation and anticoagulation was evaluated on All-cause mortality at 3 months in patients diagnosed with PE and discharged with anticoagulation (95% CI 4.56-6.83). In patients diagnosed with pulmonary embolism and discharged with anticoagulation, 3-month all-cause mortality was 5.69% (95% CI, 4.56-6.83) and recurrent VTE was 1.38%.
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