Incidence of residual perfusion defects by lung scintigraphy in patients treated with rivaroxaban compared with warfarin for acute pulmonary embolism

  • Ming Sheng LimEmail author
  • Dee Nandurkar
  • Ian Jong
  • Anita Cummins
  • Huyen Tran
  • Sanjeev Chunilal


Residual perfusion defects (RPD) as detected by lung scintigraphy occur in over 50% of patients with acute pulmonary embolism (PE) treated with vitamin K antagonists but there is lack of data in patients treated with direct oral anticoagulants. The aim of this retrospective study was to estimate the incidence of RPD detected by ventilation perfusion (VQ) scan at 3–6 months in patients with first acute symptomatic PE treated with rivaroxaban compared to warfarin. Consecutive eligible patients treated with rivaroxaban as part of a previous study were identified. The Monash Health Radiology database was used to identify a historical cohort of age matched (± 5 years) patients treated with warfarin. Follow-up VQ scans were classified as normal (no perfusion defect) or abnormal (matched or unmatched perfusion defects) by two independent nuclear medicine physicians blinded to treatment. Any disagreement was resolved by consensus. One hundred and ninety patients with PE (95 in each cohort) were included (mean age 56.8 years; 41.1% males; 54.2% unprovoked). In the overall cohort, 31.1% had RPD with a significantly lower incidence of RPD in rivaroxaban treated patients 23.2% (95% CI 15.8–32.6), compared to warfarin 38.9% (95% CI 29.8–49.0). Treatment with rivaroxaban was associated with a significantly lower incidence of RPD detected by VQ scan at 3–6 months compared to warfarin. This supports recent in-vitro data suggesting an indirect enhancement of fibrinolysis by direct oral Xa inhibitors but requires confirmation in larger studies.


Anticoagulants Pulmonary embolism Rivaroxaban Ventilation–perfusion scan Warfarin 


Author contributions

MSL and SC were involved in the conception and design of the project. MSL and AC were involved in data acquisition. MSL, DN, IJ, SC, and HT were involved in data analysis and interpretation. MSL wrote the first draft of the manuscript. All authors contributed to critical revision of the manuscript and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

S Chunilal received grants from Bayer Pharma during the conduct of the study and advisory board fees from Bayer Pharma outside the submitted work; H Tran received grants and honorarium from Bayer Health, grants from Pfizer and honorarium from Boehringer-Ingelheim, all outside the submitted work. All other authors declare no conflict of interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Haematology DepartmentMonash Medical Centre, Monash HealthClaytonAustralia
  2. 2.Diagnostic ImagingMonash HealthMelbourneAustralia
  3. 3.The Australian Centre for Blood DiseasesMonash University, Alfred Medical Research and Educational PrecinctMelbourneAustralia
  4. 4.Clinical Haematology DepartmentThe Alfred HospitalMelbourneAustralia
  5. 5.Faculty of Medicine Nursing and Health ScienceMonash UniversityMelbourneAustralia

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