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

1Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Nuclear Medicine Department, Brest, France, Brest, Bretagne, France, 2Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada, Ottawa, Ontario, Canada, 3Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada, Ottawa, Ontario, Canada, 4University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, 5Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Departement de Medecine Interne et Pneumologie, Brest, France, Brest, Bretagne, France, 6Department of Internal Medicine and Chest Diseases, CHU de Brest, Brest, Bretagne, France, 7APHP, Paris, Ile-de-France, France, 8Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France, Paris, Ile-de-France, France, 9Department of Internal Medicine, University of Padua, Padua, Italy, Padua, Veneto, Italy, 10Department of Medicine, McGill University, Montreal, QC, Canada, Montreal, Quebec, Canada, 11Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada, London, Ontario, Canada, 12Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, 13Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada, Ottawa, Ontario, Canada

Abstract Number: PB0973

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » VTE Diagnosis

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.

The association between RPVO and the risk of recurrence

Abbreviations: n: number; IQR: Interquartile range, CI: Confidence interval; RPVO: residual pulmonary vascular obstruction

To cite this abstract in AMA style:

Robin P, Le Pennec R, Eddy M, Sikora L, Le Roux P, Carrier M, Couturaud F, Tromeur C, Planquette B, Sanchez O, Pesavento R, Rodger M, Kovacs M, Mallick R, Salaun P, Le Gal G. Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: a systematic review and meta-analysis of individual participant data [abstract]. https://abstracts.isth.org/abstract/residual-pulmonary-vascular-obstruction-and-recurrence-after-acute-pulmonary-embolism-a-systematic-review-and-meta-analysis-of-individual-participant-data/. Accessed August 16, 2022.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/residual-pulmonary-vascular-obstruction-and-recurrence-after-acute-pulmonary-embolism-a-systematic-review-and-meta-analysis-of-individual-participant-data/