From the Guidelines
Having a PFT after being diagnosed with PE 2 months ago is not contraindicated, as most patients can safely undergo PFTs after adequate treatment and stabilization from a PE, according to the 2019 ESC guidelines on the diagnosis and management of acute pulmonary embolism 1.
Key Considerations
- The 2019 ESC guidelines emphasize the importance of follow-up examinations after acute PE, including checking for possible signs of VTE recurrence, cancer, or bleeding complications of anticoagulation 1.
- Patients should be evaluated for persisting or new-onset dyspnoea or functional limitation, and a staged diagnostic workup should be implemented to exclude CTEPH or chronic thrombo-embolic disease, and to detect/treat comorbidity or ‘simple’ deconditioning 1.
- Follow-up imaging is not routinely recommended in an asymptomatic patient, but it may be considered in patients with risk factors for the development of CTEPH 1.
- PFTs can be helpful in assessing any residual effects the PE may have had on lung function, and individual circumstances should be taken into account before proceeding with the test.
Recommendations
- Inform the technician about your recent PE history before undergoing a PFT, as they may need to modify certain aspects of the testing protocol.
- Continue anticoagulants like warfarin, apixaban, or rivaroxaban as prescribed before your PFT, as they do not interfere with the testing.
- Evaluate individual circumstances, such as significant shortness of breath, chest pain, or other concerning symptoms, before proceeding with the PFT.
From the Research
Pulmonary Function Test (PFT) After Pulmonary Embolism (PE)
- There is no direct evidence to suggest that having a PFT after being diagnosed with PE 2 months ago is contraindicated 2, 3, 4, 5, 6.
- However, studies suggest that patients with PE may experience persistent symptoms such as exertional dyspnea or pain for several months to years after diagnosis 3.
- A study found that exercise capacity and ventilatory efficiency improved significantly in PE patients after 6 months of anticoagulation therapy 3.
- The European Society of Cardiology recommends a holistic approach to follow-up care for patients with acute PE, including assessment of modifiable risk factors for bleeding and dedicated surveillance for the potential development of chronic thromboembolic pulmonary hypertension 4.
- There is no specific guidance on the timing of PFTs after PE diagnosis, but it is likely that PFTs would be performed as part of routine follow-up care to assess lung function and exercise capacity 3, 4.
Considerations for PFT After PE
- Patients with PE may have underlying conditions that affect lung function, such as chronic obstructive pulmonary disease (COPD) or pulmonary hypertension 2, 5.
- PFTs may be useful in assessing the severity of lung function impairment and guiding treatment decisions 3, 4.
- However, the decision to perform a PFT after PE diagnosis should be made on a case-by-case basis, taking into account the individual patient's clinical status and medical history 4, 5.