RT Journal Article
T1 Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial.
A1 Jiménez, David
A1 Agustí, Alvar
A1 Tabernero, Eva
A1 Jara-Palomares, Luis
A1 Hernando, Ascensión
A1 Ruiz-Artacho, Pedro
A1 Pérez-Peñate, Gregorio
A1 Rivas-Guerrero, Agustina
A1 Rodríguez-Nieto, María Jesús
A1 Ballaz, Aitor
A1 Agüero, Ramón
A1 Jiménez, Sonia
A1 Calle-Rubio, Myriam
A1 López-Reyes, Raquel
A1 Marcos-Rodríguez, Pedro
A1 Barrios, Deisy
A1 Rodríguez, Carmen
A1 Muriel, Alfonso
A1 Bertoletti, Laurent
A1 Couturaud, Francis
A1 Huisman, Menno
A1 Lobo, José Luis
A1 Yusen, Roger D
A1 Bikdeli, Behnood
A1 Monreal, Manuel
A1 Otero, Remedios
A1 SLICE Trial Group, 
AB Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD). To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation. Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020). Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367). The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected. Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, -6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, -2.0% [95% CI, -4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, -3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, -1.7% [95% CI, -5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, -1.9% to 1.8%]; P = .99). Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome. ClinicalTrials.gov Identifier: NCT02238639.
YR 2021
FD 2021
LK https://hdl.handle.net/10668/27333
UL https://hdl.handle.net/10668/27333
LA en
DS RISalud
RD Apr 6, 2025