A Study to Evaluate the Safety of Withholding Anticoagulation in Patients With Subsegmental PE Who Have a Negative Serial Bilateral Lower Extremity Ultrasound (SSPE)
Blood clots in lung arteries (pulmonary embolism) are usually detected using a radiological test called computed tomography (CT scan). As technology advances, the CT scans are able to detect smaller and smaller blood clots. Over time, the frequency of blood clots in the pulmonary arteries has increased significantly (CT scan are now detecting very small blood clots that the investigators could not see before). As a result, more and more people are on blood thinners to treat these small blood clots but their true clinical significance is unknown.
The management of blood thinners is costly and also utilizes scarce healthcare resources. These blood thinners need to be monitored with frequent blood work. Furthermore, every year, approximately 3 percent of patients on blood thinners will have a major bleeding event requiring medical attention.
The investigators don't think that treating these small blood clots in the pulmonary arteries detected on CT scan is worth the risk of bleeding from the blood thinners.
The main goal of this study is to find out if it is safe to not treat very small blood clots in the pulmonary arteries.
The investigators plan to follow 300 patients with small blood clots in their lungs for 90 days. These patients will not be treated with blood thinners but will be followed closely with other non-invasive tests to avoid progression or recurrence of blood clots.
Subsegmental (Single or Multiple) Pulmonary Embolism
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||A Multicenter Prospective Cohort Management Study to Evaluate the Safety of Withholding Anticoagulation in Patients With Subsegmental PE Who Have a Negative Serial Bilateral Lower Extremity Ultrasound|
- Recurrent VTE [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]Recurrent VTE will be diagnosed according to previously published criteria: 1)Lower extremity US revealing non-compressibility at the trifurcation of the popliteal vein or above; OR 2) Venography demonstrating a constant intraluminal filling defect above the trifurcation of the popliteal vein; OR 3) Pulmonary angiography demonstrating a new constant intraluminal filling defect or a cut off of a vessel; OR 4) Ventilation/perfusion scanning with a high probability of PE; OR 5) CTPA demonstrating new intraluminal filling defect in a subsegmental or greater sized pulmonary artery; OR 6) PE discovered at autopsy.
- Interobserver agreement for SSPE diagnosis on CTPA (local Vs. central interpretation) [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]
- Death due to PE [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]Definition of death due to PE Certain: hypotension, hypoxia, cardiac arrest with no other explanation other than PE and autopsy or radiographic confirmation Highly probable: criteria for certain but another disease could have caused the death Probable: other cause suspected based on clinical evidence but 100% certainty not available Unlikely: all other cases
- Death probably due to PE [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]Certain: hypotension, hypoxia, cardiac arrest with no other explanation other than PE and autopsy or radiographic confirmation Highly probable: criteria for certain but another disease could have caused the death Probable: other cause suspected based on clinical evidence but 100% certainty not available Unlikely: all other cases
- Major bleeding [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]
Major bleeding will be defined according to previously published criteria (51):
- Fatal bleeding; OR
- Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome; OR
- Bleeding causing a fall in hemoglobin level of 20 g/L (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells
- Minor bleeding [ Time Frame: 90 day follow-up ] [ Designated as safety issue: Yes ]Minor bleeding will be defined as any bleeding not meeting the requirements of a major bleeding event.
|Study Start Date:||March 2011|
|Estimated Study Completion Date:||June 2017|
|Estimated Primary Completion Date:||June 2017 (Final data collection date for primary outcome measure)|
Please refer to this study by its ClinicalTrials.gov identifier: NCT01455818
|Contact: Isabel Dao, CCRP||613-737-8899 ext email@example.com|
|Contact: Amanda Pecarskie, CCRC||613-737-8899 ext firstname.lastname@example.org|
|Canada, Nova Scotia|
|Capital District Health Authority||Recruiting|
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|Principal Investigator: Sudeep Shivakumar, MD|
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|Contact: Michael Kovacs, MD MSc|
|Principal Investigator: MIchael Kovacs, MD MSc|
|Ottawa, Ontario, Canada, K1H 8L6|
|Contact: Amanda Pecarskie, CCRC 613-737-8899 ext 71065 email@example.com|
|Principal Investigator: Marc Carrier, MD MSc|
|Toronto General Hospital||Recruiting|
|Toronto, Ontario, Canada, M5G 2C4|
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|Principal Investigator: Marc Righini, MD PhD|