Scan Technology Tied to Overtreatment of Clots in
MONDAY, May 9 (HealthDay News) -- Overdiagnosis and
overtreatment of pulmonary embolism is a problem in the United
States due to the large increase in the use of computed tomography
pulmonary angiography (CTPA), a new study suggests.
A pulmonary embolism (PE) is a potentially life-threatening
blood clot in the lungs. CTPA was introduced in 1998 to improve
detection of PE and its use has grown rapidly, according to
background information in the study by Boston University School of
The investigators compared data about PE in U.S. adults before
(1993-1998) and after (1998-2006) CTPA was introduced, and found
that the incidence of PE increased 81 percent after CTPA became
available, from 62.1 to 112.3 per 100,000 people.
Deaths from PE decreased during both time periods, but more so
before (8 percent reduction, from 13.4 to 12.3 per 100,000), than
after the introduction of CTPA (3 percent reduction, from 12.3 to
11.9 per 100,000 people), the research team reported.
There was also a slight improvement in case fatality before CTPA
(8 percent decrease, from 13.2 to 12.1 percent of patients) and a
substantial improvement after CTPA (36 percent decrease, from 12.1
to 7.8 percent of cases), according to the report published in the
May 9 issue of the
Archives of Internal Medicine.
While CTPA offers many benefits, the downside is that it can
detect clots so small that they might never cause symptoms or
death, yet the treatment for these clots, known as anti-clotting
therapy, may be harmful to patients, the researchers said.
"Overdiagnosis matters because it can lead to [treatment-related] harm. While a clinically insignificant PE is by definition not harmful, treating such an embolism can cause harm such as bleeding from anticoagulation [anti-clotting therapy], which can -- in the worst case -- be fatal," lead author Dr. Renda Soylemez Wiener, an assistant professor of medicine, said in a university news release.
The frequency of presumed complications of anticoagulation for
PE was stable before CTPA, but increased 71 percent (from 3.1 to
5.3 per 100,000) after CTPA became available, the study authors
The problem of overdiagnosis and overtreatment of PE is likely
to continue to grow, according to the study authors. They called
for further research to determine whether some PE patients with
small clots can safely forgo anticoagulation treatment.
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