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Russell D. Hull, MBBS, MSc; Gary E. Raskob, MSc; Geoffrey Coates, MBBS; Akbar A. Panju, MBChB; Gerald J. Gill, MD

Arch Intern Med. 1989;149(11):2549-2555.

Abstract
• Pulmonary embolism is associated strongly with proximalvein thrombosis. We tested the hypothesis that recurrent venous thromboembolism is unlikely in the absence of proximal-vein thrombosis. We performed a prospective cohort study in 874 patients with suspected pulmonary embolism. On long-term follow-up of 371 patients with the following characteristics: (1) abnormal, non–high-probability lung scans, (2) off anticoagulant therapy, and (3) serial noninvasive test results negative for proximal-vein thrombosis, only 10 (2.7%; 95% confidence limits, 1.3% to 4.9%) had venous thromboembolism. By comparison, venous thromboembolism on follow-up occurred in 3(1%) of 315 patients (95% confidence limits, 0.2% to 2.8%) with normal lung scans, and in 5(7%) of 66 patients (95% confidence limits, 2.5% to 16.8%) with high-probability lung scans. Patients whose serial noninvasive test results were negative for proximal-vein thrombosis have a good prognosis without anticoagulant therapy.

(Arch Intern Med. 1989;149:2549-2555)

Author Affiliations
From the Sections of Medicine and Diagnostic Imaging, and Department of Clinical Epidemiology and Biostatistics, Chedoke-McMaster Hospitals, Hamilton, Canada. Dr Hull is now with the University of Calgary (Canada).

Footnotes
Accepted for publication June 5,1989.

Reprint requests to the Faculty of Medicine, Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, T2N 4N1 (Dr Hull).

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