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.
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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