How to manage patients with symptomatic subsegmental pulmonary embolism?

Advances in modalities for the diagnosis of pulmonary embolism (PE) have led to a rise in the incidence of this disease. Some studies report a decrease in the case‑fatality rate of PE with no changes in the mortality rate, suggesting potential overdiagnosis. A growing number of diagnoses of less severe, smaller PE (ie, perfusion defects affecting pulmonary arteries of smaller caliber) of unknown clinical significance may potentially explain this phenomenon. Potentially higher rates of false-positive results are also an important matter of clinical concern. Only low-quality evidence suggested that subsegmental PE may be safely managed without initiating anticoagulation. Based on an individualized risk-benefit ratio, current clinical practice guidelines suggest that a selected group of patients with subsegmental PE, deemed to be at low risk of recurrence and without concomitant deep vein thrombosis detected by serial bilateral leg ultrasound, might benefit from clinical surveillance instead of anticoagulation. This approach is currently assessed in an ongoing prospective cohort study.