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Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without
Grégoire Le Gal1, Michael J Kovacs2, Laurent Bertoletti3
1Centre d'Investigation Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France, and Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (G.L.).
Annals of Internal Medicine
|November 22, 2021
Summary
Patients with subsegmental pulmonary embolism without deep vein thrombosis had a higher-than-expected rate of recurrent venous thromboembolism. This suggests careful consideration for anticoagulation in these low-risk cases.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Vascular Medicine
Background:
- Pulmonary embolism (PE) incidence is rising, yet case-fatality is declining, indicating potentially less severe presentations.
- The clinical significance of isolated subsegmental pulmonary embolism (PE) remains unclear.
Purpose of the Study:
- To investigate the recurrence rate of venous thromboembolism (VTE) in patients with isolated subsegmental PE managed without anticoagulation.
Main Methods:
- A multicenter prospective cohort study involving 266 patients with isolated subsegmental PE.
- Patients underwent lower-extremity venous ultrasonography; those without deep venous thrombosis (DVT) did not receive anticoagulant therapy.
- Recurrent VTE was monitored over a 90-day follow-up period.
Main Results:
- The cumulative incidence of recurrent VTE was 3.1% within 90 days.
- Recurrence rates were 2.1% for single and 5.7% for multiple subsegmental PEs.
- No fatal recurrent PE events were observed.
Conclusions:
- Patients with subsegmental PE and no proximal DVT experienced a higher-than-anticipated VTE recurrence rate.
- This finding suggests that even low-risk subsegmental PE may warrant anticoagulation therapy.
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