Adding PE diagnostic strategy failed to improve outcomes in patients hospitalized with COPD

In patients hospitalized with COPD exacerbations, those who received usual care plus an active strategy for diagnosing pulmonary embolism did not have improved outcomes compared with those who received usual care only.

“Although observational studies and meta-analyses have assessed the prevalence of PE among patients who have exacerbations of COPD, to our knowledge, no clinical trials have evaluated whether an active search for PE might improve clinical outcomes,” David Jiménez, MD, PhD, respiratory department at the Ramón and Cajal Hospital and Ramón and Cajal Institute of Health Research, Madrid, and colleagues wrote in JAMA.

The multicenter, randomized SLICE trial included 746 patients hospitalized for COPD exacerbations across 18 hospitals in Spain. Patients were randomly assigned from September 2014 to July 2020 to receive usual care plus an active PE diagnosis strategy (n = 370) or usual care alone (n = 367).

Usual care generally consisted of supplemental oxygen, short-acting inhaled beta agonists and short-acting anticholinergic agents, systemic corticosteroids, antibiotics and pharmacological thromboprophylaxis. The active search for PE involved the use of D-dimer testing within 12 hours and a CT pulmonary angiogram.

A total of 737 patients (mean age, 70 years; 26% women) completed the trial. with the primary outcome, a composite of nonfatal symptomatic venous thromboembolism, COPD readmission or death within 90 days occurred in 29.7% of patients in the intervention group compared with 29.2% of patients in the usual care-only group (RR = 1.02; 95% CI 0.82-1.28; P = .86). Researchers observed no significantly different rates in secondary outcomes such as nonfatal new or recurrent VTE between the intervention and usual care-only groups (0.5% vs. 2.5%).

At 90 days, 25.4% of patients in the intervention group and 22.9% in the usual care-only group required readmission due to COPD exacerbation (risk difference = 2.5%; 95% CI, –3.9% to 8.9%).

Death from any cause occurred in 6.2% of patients in the intervention group compared with 7.9% in the usual care-only group (risk difference = –1.7%; 95% CI, –5.7% to 2.3%). In addition, major bleeding occurred in six patients (three in the intervention group; three in the usual care-only group).