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Department of Nuclear Medicine, Marie Lannelongue Surgical Center, Le Plessis-Robinson
Department of Nuclear Medicine, Laennec Hospital, Paris, France
Correspondence: For correspondence or reprints contact: Myriam Wartski, MD, Department of Nuclear Medicine, Marie Lannelongue Surgical Center, 133 avenue de la Resistance, 92 350 Le Plessis-Robinson, France.
ABSTRACT
We assessed the time course of lung perfusion after 3 mo of anticoagulant therapy for acute pulmonary embolism (APE) on the basis of perfusion lung scan (PLS) findings for 157 patients included in the Tinzaparin ou Heparin Standard: Evaluation dans I'Embolie Pulmonaire Study (THESEE), a multicenter, randomized, nonmasked trial comparing standard, continuous, adjusted-dose intravenous heparin with once-daily, subcutaneous, low-molecular-weight heparin in patients with APE. Methods: We calculated the percentage-of-vascular-obstruction score (PVOs) on PLSs on the day of diagnosis of APE (PVOsD1), on day 8 (PVOsD8), and after 3 mo (PVOsM3) and the mean relative changes in PVOs on day 8 versus the day of diagnosis and after 3 mo versus the day of diagnosis. Results: Mean PVOsD1 ± SD was 49% ± 20%, PVOsD8 was 29% ± 18%, and PVOsM3 was 19% ± 18%. PVOsDI was at least 50% in 49% of patients. Reperfusion did not correlate with age, importance of initial obstruction, or clinical severity of disease at inclusion in THESEE. Relative change after 3 mo versus at diagnosis was lower in the 87 patients with associated prior cardiopulmonary disease than in those without. In the 43 patients with a history of thromboem-bolic disease, neither mean PVOsD1 nor the time course of PVOs was different from those in patients without a history of thromboembolic disease. Residual defects after 3 mo were observed in 104 patients (66%), including 13 with a PVOs of at least 50%. Conclusion: These results emphasize the need for a control PLS at completion of anticoagulant therapy for APE, even in patients with full resolution of symptoms.
Key Words: acute pulmonary embolism • perfusion lung scan • residual perfusion defects
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