Active diagnostic strategy for pulmonary embolism in COPD exacerbations does not significantly alter a composite clinical outcome compared to usual care
Dr. Lublin
Clinical question: Can an active diagnostic protocol including a D-dimer and computed tomography pulmonary angiogram (CTPA) for pulmonary emboli (PE) improve outcomes for patients presenting with COPD exacerbations?
Background: PE are common in patients with COPD exacerbations. It is unknown if an active search for PE in every COPD exacerbation can improve outcomes.
Study design: Randomized clinical trial.
Setting: Eighteen hospitals across Spain, September 2014 to July 2020.
Synopsis: The 746 patients hospitalized for COPD exacerbation were randomized to the active diagnostic strategy or usual care. The primary composite outcome was symptomatic venous thromboembolism, readmission, and death within 90 days. There was no significant difference in the primary outcome between the two groups. Similarly, there were no significant differences between the groups for individual components of the primary outcome. The study may have been underpowered to detect differences in secondary outcomes.
Bottom line: Compared to usual care alone, an active diagnostic protocol for PE does not improve clinical outcomes in patients with acute COPD exacerbations.
Citation: Jimenez D et al. Effect of a pulmonary embolism diagnostic strategy on clinical outcomes in patients hospitalized for COPD exacerbation: A randomized clinical trial. JAMA. 2021:326(13):1277-1285.
Dr. Lublin is an assistant professor of medicine at the University of Colorado School of Medicine hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.