INTRODUCTION: The Wells clinical decision rule (CDR) and D-dimer tests can be used to exclude pulmonary embolism (PE). We performed a meta-analysis to determine the negative predictive value (NPV) of an "unlikely" CDR (<or=4 points) combined with a normal D-dimer test and the safety of withholding anti-coagulants based on these criteria. METHODS: Prospective studies that withheld anti-coagulant treatment from patients with clinically suspected PE and an "unlikely" CDR in combination with a normal D-dimer concentration without performing further tests were searched for in Medline, Cochrane and Embase. Primary endpoints were the recurrence rate of venous thromboembolism (VTE) and PE-related mortality during 3-months follow-up. RESULTS: Four studies including 1660 consecutive patients were identified. The pooled incidence of VTE after initial exclusion of acute PE based on an "unlikely" CDR and normal D-dimer was 0.34% (95%CI 0.036-0.96%), resulting in a NPV of 99.7% (95%CI: 99.0-99.9%, random effects-model). The risk for PE related mortality was very low: 1/1660 patients had fatal PE (0.06%, 95%CI 0.0017-0.46%). CONCLUSION: Acute PE can be safely excluded in patients with clinically suspected acute PE who have an "unlikely" probability and a negative D-dimer test and anticoagulant treatment can be withheld. There is no need for additional radiological tests in these patients to rule out PE. (c) 2009 Elsevier Ltd. All rights reserved.
INTRODUCTION: The Wells clinical decision rule (CDR) and D-dimer tests can be used to exclude pulmonary embolism (PE). We performed a meta-analysis to determine the negative predictive value (NPV) of an "unlikely" CDR (<or=4 points) combined with a normal D-dimer test and the safety of withholding anti-coagulants based on these criteria. METHODS: Prospective studies that withheld anti-coagulant treatment from patients with clinically suspected PE and an "unlikely" CDR in combination with a normal D-dimer concentration without performing further tests were searched for in Medline, Cochrane and Embase. Primary endpoints were the recurrence rate of venous thromboembolism (VTE) and PE-related mortality during 3-months follow-up. RESULTS: Four studies including 1660 consecutive patients were identified. The pooled incidence of VTE after initial exclusion of acute PE based on an "unlikely" CDR and normal D-dimer was 0.34% (95%CI 0.036-0.96%), resulting in a NPV of 99.7% (95%CI: 99.0-99.9%, random effects-model). The risk for PE related mortality was very low: 1/1660 patients had fatal PE (0.06%, 95%CI 0.0017-0.46%). CONCLUSION: Acute PE can be safely excluded in patients with clinically suspected acute PE who have an "unlikely" probability and a negative D-dimer test and anticoagulant treatment can be withheld. There is no need for additional radiological tests in these patients to rule out PE. (c) 2009 Elsevier Ltd. All rights reserved.
Authors: Long Jiang Zhang; Guang Ming Lu; Felix G Meinel; Andrew D McQuiston; James G Ravenel; U Joseph Schoepf Journal: Eur Radiol Date: 2015-03-13 Impact factor: 5.315
Authors: Ran Meng; Xiaoying Wang; Mohammed Hussain; David Dornbos; Lu Meng; Yu Liu; Yan Wu; Mingming Ning; Buonanno Ferdinando S; Eng H Lo; Yuchuan Ding; Xunming Ji Journal: Int J Stroke Date: 2013-03-19 Impact factor: 5.266