Lit Matters #2: Don’t Chase PE in All COPD Exacerbations

Pulmonary embolism can mimic a COPD exacerbation, but routine PE screening for every admitted COPD flare did not improve 90-day patient-oriented outcomes in the SLICE randomized trial. The practical takeaway is selective PE workup based on clinical suspicion, not reflex D-dimer testing for all.

PE Testing in COPD Exacerbation

• SLICE trial takeaway: Hospitalized COPD exacerbation patients did not have better 90-day outcomes with a formal PE search strategy than with usual care, despite more testing and more emboli found upfront.
• Selective suspicion matters: Patients in whom PE was already clinically suspected were excluded, reinforcing the real message: investigate PE when the story points there, not just because COPD and PE can overlap.
• D-dimer first strategy: The intervention used D-dimer followed by CT pulmonary angiography if positive; about half had a negative D-dimer, and we get into why that still did not translate into better outcomes in the episode.
• Detected PE burden: Among patients with a positive D-dimer who underwent CTPA, PE was found in 8.8%, mostly without any need for fibrinolysis, thrombectomy, or IVC filter-level escalation.
• Patient oriented outcomes: The primary composite outcome was essentially identical at 90 days, about 30% in both groups, which undercuts routine PE risk stratification as a default admission pathway.
• Bedside practice shift: If it looks like COPD and acts like COPD, routine PE workup is not mandatory; reserve imaging and anticoagulation decisions for cases with genuine PE signals or atypical deterioration.