Interest of check-up before discontinuing anti thrombotic therapy after a first episod of pulmonary embolism

Although numerous pulmonary embolism (PE) guidelines are available, there is still concern about specific point of management. Interest of checkup before discontinuing anti thrombotic therapy (ATT) in eligible patients is one of this question. To investiguate this we have retrospectively studied all patients treated for PE in our unit during two consecutive years. We have identified 100 cases of PE of which 84 first episod. Among this 84 patients, 3 died during hospitalisation (3,6%). Among the 81 survivors, 25 (31%) underwent a 3 months checkup, 2 (2%) died between the 3rd and 6th month, 15/79 (19%) underwent a 6 months checkup, 19/81 (23%) haven’t had follow up, 20/81 (25%) have had anarchical follow up. Among the 25 patients who underwent a 3 months checkup, 18 (72%) have realised a ventilation & perfusion scintigraphy (VPS), 6 (24%) an angio CT, 6 (24%) an echocardiography and 3 (12%) a veinous doppler of the legs (VDL). Treatment was discontinued for 8 (32%) and maintain for 12 (48%). There wasn’t information in 5 cases (20%). Among the 15 patients who underwent a 6 months checkup, 6 (40%) have realised a VPS, 5 (33%) an angio CT, 7 (47%) an echocardiography and none (0%) a VDL. Treatment was discontinued for 13 (87%) and maintain for 2 (13%). This study shows that a great number of exams are realised in order to discontinue the ATT after a first episod of PE while only 1/3 is discontinued in the patients who underwent a checkup at three months and nearly 9/10 in the patients who underwent a 6 months checkup. This study emphasises the need of strong data in order to determine if a checkup is required to discontinue an ATT after a first episod of pulmonary embolism.