First10 EM - By Justin Morgenstern - July 11, 2022
The paper
Le Gal G, Kovacs MJ, Bertoletti L, et al. Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation : A Multicenter Prospective Cohort Study. Ann Intern Med. 2022 Jan;175(1):29-35. doi: 10.7326/M21-2981. Epub 2021 Nov 23. PMID: 34807722
Bottom line
At this point, we don’t know the true incidence of recurrent VTE after an isolated subsegmental PE diagnosis. Although there are many sources of bias in this data, the 3% recurrence rate in this study suggests that recurrence is unlikely to be completely negligible. In patients with risk factors, DVTs, and perhaps multiple subsegmental PEs, treatment is probably warranted until we see better data.
In my mind, the best approach is limiting testing to high risk patients in the first place. If I find a subsegmental PE in a patient I thought was high risk for PE, I have no problem treating it. The problem only arises when you really didn’t think the patient had a PE, but got the test for some reason anyway, and found a subsegmental.