This article is more than 5 years old. Information may no longer be current.
Patients with SSPE appear to imitate those with segmental, proximal PE
Click Here to Manage Email Alerts
Patients with subsegmental pulmonary embolism appeared to mimic patients with more proximally located pulmonary embolism with regard to their venous thromboembolism risk profile and clinical outcome, according to study results.
In addition, researchers found that those with subsegmental pulmonary embolism significantly differed from patients without PE with regard to VTE risk profile and clinical outcome.
“These findings challenge the hypothesis that a diagnosis of subsegmental pulmonary embolism might be clinically insignificant,” the researchers wrote.
For the study, researchers set out to identify the clinical significance of subsegmental PE in 3,728 patients with clinically suspected PE. Specifically, they aimed to identify whether subsegmental PE forms a subset of thromboembolic disease when compared with a more proximally located PE.
PE was confirmed in 748 patients and ruled out in 2,980 patients. Sixteen percent of patients with PE had subsegmental PE.
Researchers reported no differences in the 3-month risk for recurrent VTE (3.6% vs. 2.5%; P=.42) or mortality (10.7% vs. 6.5%; P=.17) between those with subsegmental PE and more proximal PE.
Researchers identified several independent predictors for subsegmental PE, including age older than 60 years, male gender, estrogen use and recent surgery. Patients with subsegmental PE were at increased risk of VTE during follow-up (HR=3.8; 95% CI, 1.3-11.1) compared with those without PE.
"There is a need for prospective studies assessing the outcome and management of subsegmental PE before considering distinct management guidelines for this specific group of PE patients," the researchers wrote."A prospective management study assessing the safety of withholding anticoagulation in patients with isolated symptomatic subsegmental PE, without DVT on bilateral lower extremity compression ultrasonography, is currently being conducted."
Disclosure:The researchers report no relevant financial disclosures.
Perspective
Back to Top
Harry S. Jacob, MD, FRCPath(Hon)
The data indicating that subsegmental (ie, smaller) emboli are more likely in older patients and those who are liable to recurrent DVT suggest many may have congenital hypercoagulability, such as Factor V Leiden. It will be interesting to document this hypothesis, as it may foster workup for these otherwise-unsuspected mutations.
Collapse
Click Here to Manage Email Alerts