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The Management of SubSegmental Pulmonary Embolism without Anticoagulation

1Ottawa Hospital Research Institute, Ottawa, Canada, 2Schulich School of Medicine and Dentistry, Western University, London, Canada, 3CHRU Brest, Brest, France, 4McGill University, Montreal, Canada, 5Leiden University Medical Center, Leiden, Netherlands, 6Amsterdam Medical Center, Amsterdam, Netherlands, 7University of Geneva, Geneva, Switzerland, 8Centre Hospitalier Universitaire d’Angers, Angers, France, 9Hôpital Européen Georges Pompidou, Paris, France, 10Clermont-Ferrand University Hospital, Clermont-Ferrand, France, 11McMaster University, Hamilton, Canada, 12Dalhousie University, Halifax, Canada, 13Centre Hospitalier d’Agen-Nérac, Angen, France, 14Centre Hospitalier Régional Universitaire de Brest, Brest, France, 15University of Alberta, Edmonton, Canada, 16University of Toronto, Toronto, Canada

Abstract Number: LB 01.4

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » VTE Treatment

Background: The incidence of pulmonary embolism has been increasing over the past decades without any changes in the overall mortality rate and a decreasing case fatality rate suggesting overdiagnosis and a lower severity of illness. Whether patients with pulmonary embolism isolated to the subsegmental vessels may be managed without anticoagulation remains unknown.

Aims: We conducted a multinational prospective cohort study assessing the management of patients with single or multiple isolated subsegmental pulmonary embolism.

Methods: Eligible patients underwent repeated bilateral lower extremity venous ultrasonography. Patients without proximal deep vein thrombosis did not receive anticoagulant therapy. The primary outcome was recurrent venous thromboembolism during the 90-day follow-up period.

Results: Recruitment was stopped prematurely because of meeting the pre-defined stopping rule after 292 patients, of a projected 300 (97%), were enrolled. A total of 18 (6.2%) and 10 (3.4%) patients had a deep vein thrombosis on initial or repeated bilateral ultrasonography, respectively. Twenty of these patients were initiated on anticoagulation and 6 additional patients were initiated on anticoagulation for other reasons. A total of 266 patients were included in the primary analysis. The mean age was 56 years and more patients were women (53%). The most common presenting symptoms were chest pain (73%) and shortness of breath (59%).The primary outcome occurred in 8 patients, for a cumulative incidence of 3.1% (95% CI: 1.6 to 6.1) over the 90-day follow-up period. The incidence of recurrent venous thromboembolism was 2.1% (95% CI: 0.8 to 5.5) and 5.7% (95%CI: 2.2 to 14.4) in patients with single and multiple isolated subsegmental pulmonary embolism, respectively. No patients had a recurrent fatal pulmonary embolism.Cumulative Incidence of Recurrent venous thromboembolism

Conclusions: Overall, patients with isolated subsegmental pulmonary embolism who do not have proximal deep vein thrombosis had a higher than expected rate of recurrent venous thromboembolism. This has implications for the anticoagulation management of these patients in clinical practice (NCT01455818).

To cite this abstract in AMA style:

Le Gal G, Kovacs M, Couturaud F, Hirsch A, Huisman M, Klok E, Kraaijpoel N, Righini M, Rodger M, Roy P-, Sanchez O, Schmidt0 J, Schulman S, Shivakumar S, Trinh-Duc A, Vinsonneau U, Wells P, Wu C, Yeo E, Carrier M. The Management of SubSegmental Pulmonary Embolism without Anticoagulation [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-management-of-subsegmental-pulmonary-embolism-without-anticoagulation/. Accessed November 28, 2023.

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