Rates of Overtreatment and Treatment-Related Adverse Effects Among Patients With Subsegmental Pulmonary Embolism

Raslan, Ismail A.; Chong, Jaron; Gallix, B.; Lee, Todd C.; McDonald, Emily G.

doi:10.1001/jamainternmed.2018.2971

Cited by 37 publications

(33 citation statements)

References 6 publications

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“…Our finding that the vast majority of patients with isolated SSPE are managed with anticoagulation treatment is consistent with the results from surveys and other studies [6,38,39]. We did not observe a statistically significant difference in the duration of initial anticoagulation in patients with SSPE and more proximal PE, demonstrating that physicians do not primarily use the localization of PE to determine the duration of anticoagulant treatment.…”

Section: Discussionsupporting

confidence: 90%

“…Acute isolated subsegmental pulmonary embolism (SSPE), defined as pulmonary embolism (PE) that occurs in one or more subsegmental pulmonary artery branches but no larger order of vessels [1], is increasingly detected with the technological advance in computed tomography pulmonary angiography (CTPA) [2]. SSPE represents 7-36% of cases of PE [3][4][5][6], and the vast majority of patients with SSPE receive anticoagulant treatment [6]. However, the diagnosis and treatment of SSPE pose several challenges.…”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Stoller

Limacher

Méan

et al. 2019

Thrombosis Research

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Stoller

Limacher

Méan

et al. 2019

Thrombosis Research

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“…[12][13][14] Nevertheless, the clinical relevance of these subsegmental PE is unclear. 12,13,17 Study results regarding anticoagulation benefits for patients with isolated subsegmental PE differ and, in daily clinical practice, there is no consistent therapeutic approach in these cases. 13,[17][18][19][20][21] In summary, however, current guidelines recommend an analogous treatment to patients with symptomatic PE, especially in the cases with high-risk profiles according to the Wells score.…”

Section: Discussionmentioning

confidence: 99%

Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

Trenker

Dohse

Ramaswamy

et al. 2019

J of Clinical Ultrasound

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Objective The purpose of this case series is to evaluate the diagnostic potential of contrast‐enhanced ultrasound (CEUS) in patients with clinically suspected pulmonary embolism (PE), suspicious pleural lesions, and negative computed tomography pulmonary angiogram (CTPA). Patients/Methods Between January 2017 and January 2018, we examined patients with an intermediate or a high‐risk Wells score and a negative CTPA with lung B‐mode ultrasound (LUS). In a total of six patients, pleural defects were identified and further examined by CEUS. Nonenhancing lesions or those with inhomogeneous enhancement were considered to be suspicious for an embolic event and biopsied for histological validation. The data analysis was retrospective. Results In LUS, the lesions had an average size of 2.4 cm (range 2‐3 cm). Five were hypoechoic and one was complex. The shape was wedge shaped (n = 5) or round (n = 1), and the number was solitary (n = 4) or multiple (n = 2) with dorsobasal localization (n = 6). Three lesions were nonenhancing, and three had an inhomogeneous enhancement with areas with complete absence of enhancement. The histological examination showed pulmonary infarction in all six cases, and in one patient also cells of a lung carcinoma. Conclusion Our case series demonstrates the diagnostic potential of CEUS for detecting peripheral pulmonary infarction in patients with clinically suspected PE and negative CTPA scan regarding PE. A histological validation or a narrow follow‐up might be warranted in some cases.

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“…73,77,78 A retrospective study reported on 9 patients with SSPE who did not receive anticoagulation due to an overall poor prognosis and the risk of bleeding complications. 57 The decision to treat patients with symptomatic SSPE or withhold anticoagulation in this population should be made after weighing the risk of both recurrent VTE and major bleeding complications.…”

Section: Outcomes Of Patients With Subsegmental Pulmonarymentioning

confidence: 99%

How to manage patients with symptomatic subsegmental pulmonary embolism?

Roberge

Carrier

2020

Polish Archives of Internal Medicine

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in diameter better than single-detector CTPA. 15-17 Over the years, refined clinical assessment in combination with D-dimer testing and other imaging techniques (eg, CTPA) made invasive strategies (ie, pulmonary angiography) unnecessary in diagnosing PE. 18-26 Due to the greater accessibility of CTPA and its ability to provide information on a possible alternative diagnosis, the use of ventilation-perfusion (V/Q) scanning has also decreased significantly. 27-29 According to a nationwide study performed in the United States, the incidence of PE has increased by 81% since CTPA was introduced. 30 This fact could be explained in different ways. Whereas a true increase in the incidence of PE (eg, due to an increased prevalence of risk factors) is possible, some studies also reported a decrease in the case-fatality rate of PE, associated with a stable or slight decrease in the mortality rate. 30-37 Although this slight improvement in mortality might be due to earlier diagnosis and better management, potential overdiagnosis of less severe PE could also be considered. Multidetector CTPA was reported to detect proportionally more cases of subsegmental pulmonary embolism (SSPE) compared with single-detector CT, and, despite an increased number of diagnoses,

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Rates of Overtreatment and Treatment-Related Adverse Effects Among Patients With Subsegmental Pulmonary Embolism

Cited by 37 publications

References 6 publications

Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

How to manage patients with symptomatic subsegmental pulmonary embolism?

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