Key result
Untreated low-risk subsegmental PE carries a ~3% VTE recurrence risk with unclear anticoagulation benefit.
Why the study?
The risk-benefit ratio of anticoagulation for low-risk patients with subsegmental pulmonary embolism remains unclear, and their optimal management is uncertain.
Does anticoagulation reduce recurrent venous thromboembolism in low-risk patients with subsegmental pulmonary embolism?
Does anticoagulation reduce recurrent venous thromboembolism in low-risk patients with subsegmental pulmonary embolism?
Recent evidence suggests withholding anticoagulation in low-risk subsegmental pulmonary embolism may carry a higher risk of VTE recurrence than previously thought, highlighting the need for randomized trials.
Withholding anticoagulation may raise VTE recurrence risk in low-risk subsegmental PE; leaves open the risk-benefit balance without RCTs.
Subsegmental pulmonary embolism (SSPE) is increasingly diagnosed with the growing use and technological advancements of multidetector computed tomography pulmonary angiography. Its diagnosis is challenging, and some presumed SSPE may actually represent imaging artifacts. Indirect evidence and results from small observational studies suggest that SSPE may be more benign than more proximal pulmonary embolism, and may thus not always require treatment. Therefore, guidelines suggest to consider a management strategy without anticoagulation in selected patients with SSPE at low risk of recurrent venous thromboembolism (VTE), in whom proximal deep vein thrombosis is excluded. Recently, a large prospective study among low-risk patients with SSPE who were left untreated showed a higher VTE recurrence risk than initially deemed acceptable by the investigators, and thus was prematurely interrupted after recruitment of 97% of the target population. However, the risk-benefit ratio of anticoagulation for low-risk patients with SSPE remains unclear, and results from randomized trials are needed to answer the question about their optimal management.
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Baumgartner et al. (2023) conducted a review in Subsegmental Pulmonary Embolism. Anticoagulation vs. Clinical surveillance was evaluated. A recent prospective study showed a 3.1% VTE recurrence risk in untreated low-risk subsegmental pulmonary embolism, but the overall risk-benefit ratio of anticoagulation remains unclear.
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