New Index Gauges Risk of Death From Thrombosis

Pezullo, M.D., assistant professor of diagnostic imaging at Brown University (Providence, RI, USA). "Consequently, patients will a high clot volume have a poor prognosis.”

Quantification of a clot size with the pulmonary arterial obstruction, also know as the CTPE index, allows physicians to triage pulmonary embolism (PE) patients based on risk. This is the first endeavor to correlate clot volume, or burden, to the clinical outcome. Up to now, little thought has been given to the implication of clot load on therapy.

The investigators utilized the CTPE index to retrospectively assess multidetector row computed tomography (MDCT) studies of 59 patients with PE to determine if a correlation exists between pulmonary embolus volume and survival. They discovered that patients with a clot burden of 60% (scoring 24 points out of 40) or greater, as calculated by the CTPE index, are at increased risk of death and may need aggressive treatment such as catheter-directed thrombolysis or thrombolytic therapy in intensive care. Five of the six patients (83%) with large clots specified by a CTPE index of 60% or greater died, whereas all but one of the 53 patients (98%) with a CTPE index of less than 60% survived.

"In the future, emergency department patients with pulmonary embolism will be stratified by risk based on how large the clot burden is,” said Dr. Pezzullo. "Patients who have very high clot burdens may be treated more aggressively than patients with minimal burdens.”

CT pulmonary angiography is noninvasive and provides high resolution of lung vessels, and is replacing traditional pulmonary angiography as a first line test for diagnosing pulmonary emboli. Studies demonstrate CT to be more cost-effective that the more invasive traditional angiography in the imaging of suspected blood clots. The investigators caution that this is an early study, and larger trials are required to corroborate the results.





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