PB0973 - Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: a systematic review and meta-analysis of individual participant data

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

PR

Philippe Robin, MD PhD

Nuclear medicine physician
Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, Brest, France
Brest, Bretagne, France
RL

Romain Le Pennec

Resident in Nuclear Medicine
Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, Brest, France
Brest, Bretagne, France
ME

Maggie Eddy

Physician
Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada
Ottawa, Ontario, Canada
LS

Lindsey Sikora

Librarian
Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
Ottawa, Ontario, Canada
PL

Pierre-Yves Le Roux

Nuclear medicine physician
Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, Brest, France
Brest, Bretagne, France
Marc Carrier, MD

MD, MSc
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
FC

Francis Couturaud

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
CT

Cecile Tromeur

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
BP

Benjamin Planquette

Physician MD
APHP
Paris, Ile-de-France, France
OS

Olivier Sanchez

MD, PhD
Georges Pompidou European Hospital, Paris, France
Paris, Ile-de-France, France
RP

Raffaele Pesavento

Physician
Department of Internal Medicine, University of Padua, Padua, Italy
Padua, Veneto, Italy
MR

Marc A. Rodger

Professor
Department of Medicine, McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
MK

Michael J. Kovacs

MD
Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
London, Ontario, Canada
RM

Ranjeeta Mallick

Research scientist
Ottawa Hospital Research Institute
Ottawa, Ontario, Canada
PS

Pierre-Yves Salaun

MD, PhD
Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Service de Médecine Nucléaire, UMR 1304, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France

Presenting Author(s)

Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Background: The optimal duration of anticoagulant therapy after a first unprovoked venous thromboembolism (VTE) is controversial due to tightly balanced risks and benefits of indefinite anticoagulation for secondary prevention of recurrence. A better assessment of the risk of recurrence after a first VTE event following discontinuation of anticoagulation is necessary to determine the optimal, individualized management strategy.

Aims: To assess the association between residual pulmonary vascular obstruction (RPVO) on planar lung scan and recurrent VTE at one year in patients with a first acute pulmonary embolism (PE) who discontinued anticoagulant therapy following an initial treatment of ≥ 3 months.

Methods: Study selection: Prospective cohort studies and randomised controlled trials in patients who experienced a first episode of objectively confirmed acute PE, completed at least 3 months of anticoagulant therapy and did not have any recurrence during this period.
Datasources: MEDLINE, EMBASE, and the Cochrane Central Registry of Controlled Trials.

Results: Four studies were identified, individual data obtained for all 809 patients. RPVO (i.e. obstruction>0%) was found in 407 patients (50.3%) after a median of 6.6 months of treatment. Recurrent VTE or death due to PE occurred in 114 patients (14.1%) for an annual risk of 6.4% (95% CI 4.7%-8.6%). Out of the 114 recurrences, 63 occurred within one year after discontinuation of anticoagulant therapy corresponding to a risk of 8.1% (6.4%,9.8%) at 1 year. Recurrent VTE occurred in 50 of 483 (10.4%, 95%CI 6.7%-15.7%) participants with RPVO < 5%, and in 64 of 326 (19.6%, 95%CI 13.5%-27.6%) participants with RPVO≥5%: hazard ratio 2.08 (95%CI 1.82-2.38).

Conclusion(s): In this individual participant data meta-analysis, RPVO is a significant predictor of the risk of recurrent events. However, the risk of recurrent events remains too high in patients without residual perfusion defect for it to be used as a stand alone test to decide on anticoagulation discontinuation.