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Pulmonary Vascular Disease |

Current Management and Outcomes of Subsegmental Pulmonary Embolism: Further Evidence to Withhold Treatment

James Ramsahai, MD; Kewan Aboulhosn, MD; Karen Laframboise, MD
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University of Saskatchewan, Saskatoon, SK, Canada


Chest. 2013;144(4_MeetingAbstracts):874A. doi:10.1378/chest.1705197
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Abstract

SESSION TITLE: Pulmonary Embolism

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: The clinical significance of isolated subsegmental pulmonary embolism (SSPE) has been questioned in recent years, while the ideal management has yet to be definitively elucidated.

METHODS: In this retrospective cross-sectional study, we examine the management of SSPE over a three year period from January 1, 2010 to December 31, 2012, at a tertiary care centre in Saskatoon, Canada. From 2458 computed tomography scans, 520 (21%) were positive for pulmonary embolism. Of these positive scans, 70 were diagnosed as SSPE and 57 of those cases were reviewed as isolated SSPE. Cases were examined with respect to the circumstance within which SSPE developed, the management choices undertaken, and outcomes including recurrence, hemorrhage, or death.

RESULTS: This study reveals that the majority, 41 patients (72%), were treated with anticoagulation, but that the remaining untreated population of 16 patients (28%) developed no significant outcomes related to recurrence of venous thromboembolism (VTE). In addition, there were no deaths recorded within 3 months of diagnosis in the untreated population without malignancy (12 patients). More importantly, the incidence of bleeding in the treated group (7%) was observed in comparison to the untreated population (0%), This rate of bleeding while anticoagulated for VTE is in agreement with that found in the literature.

CONCLUSIONS: These results demonstrate that patients with isolated SSPE may have an unfavourable risk-benefit ratio with respect to anticoagulation. This allows for a discussion on the necessity of treatment for patients with SSPE by quantifying outcomes in both the treated and untreated population with this finding.

CLINICAL IMPLICATIONS: Our results are consistent with the evolving sentiment that subsegmental pulmonary embolism may not require treatment with full anticoagulation, and provide further evidence that treatment, as well as its side effects, are not only significant, but may be avoided entirely in this population.

DISCLOSURE: The following authors have nothing to disclose: James Ramsahai, Kewan Aboulhosn, Karen Laframboise

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