Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation
Authors: Grégoire Le Gal, Michael J. Kovacs, Laurent Bertoletti, Francis Couturaud, Carole Dennie, Andrew M. Hirsch, Menno V. Huisman, Frederikus A. Klok, Noémie Kraaijpoel, Ranjeeta Mallick, Amanda Pecarskie, Elena Pena, Penny Phillips, Isabelle Pichon, Tim Ramsay, Marc Righini, Marc A. Rodger, Pierre-Marie Roy, Olivier Sanchez, Jeannot Schmidt, Sam Schulman, Sudeep Shivakumar, Albert Trinh-Duc, Rachel Verdet, Ulric Vinsonneau, Philip Wells, Cynthia Wu, Erik Yeo, Marc Carrier, Amin Zahrai, Aurélien Delluc, Lisa Duffett, Lana Castellucci, Alan Karovitch, Cathy Code, Dimitri Scarvelis, Carol Gonsalves, Melissa Forgie, Esteban Gandara, Mark Blostein, Susan Kahn, Vicky Tagalakis, Maral Koolian, Bruce Ritchie, Sarah Takach-Lapner, Jeffery Patterson, Lori Rackel, Alejandro Lazo-Langner, Judith Kovacs, Susan Solymoss, Michelle Zondag, Nicholas Forward, Mary Margaret Keating, Sue Robinson, David Anderson, Ismail Sharif, Andrea Kew, David Macdonald, Meissa Kare, Amina Chaalal, Thomas Moumneh, Béatrice Gable, Aurore Hamard, Chloé Ragueneau, Barbara Maquin, Clotilde Aubert, Cindy Augereau, Dominique Mottier, Emmanuelle Le Moigne, Sophie Boismal, Pauline Stephan, Cloé Jezequel, Raphael Le Mao, Cécile Tromeur, Claire de Moreuil, Julien Coadic, Christelle Camminada, Marc Danguy Des Déserts, Elisabeth Beuvard, Guy Meyer, Benjamin Planquette, Jean Pastre, Gisèle Morin, Alexis Ferré, Amélie Marquette, Siwar Smii, Sandrine Accassat, Carole Chauvet, Corinne Bernabet, Nadège Koffi Malan Antoine, Louise Riberdy, Nick van Es, Pieter Kamphuisen, Peter Verhamme, Jan-Beyer Westendorf, Philippe Girard, Florence Parent
Journal: Annals of Internal Medicine (2021)

Background: The incidence of pulmonary embolism has been increasing, but its case-fatality rate is decreasing, suggesting a lesser severity of illness. The clinical importance of patients with pulmonary embolism isolated to the subsegmental vessels is unknown. Objective: To determine the rate of recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation. Design: Multicenter prospective cohort study. (ClinicalTrials.gov: NCT01455818) Setting: Eighteen sites between February 2011 and February 2021. Patients: Patients with isolated subsegmental pulmonary embolism. Intervention: At diagnosis, patients underwent bilateral lower-extremity venous ultrasonography, which was repeated 1 week later if results were negative. Patients without deep venous thrombosis did not receive anticoagulant therapy. Measurements: The primary outcome was recurrent venous thromboembolism during the 90-day follow-up period. Results: Recruitment was stopped prematurely because the predefined stopping rule was met after 292 of a projected 300 patients were enrolled. Of the 266 patients included in the primary analysis, the primary outcome occurred in 8 patients, for a cumulative incidence of 3.1% (95% CI, 1.6% to 6.1%) over the 90-day follow-up. The incidence of recurrent venous thromboembolism was 2.1% (CI, 0.8% to 5.5%) and 5.7% (CI, 2.2% to 14.4%) over the 90-day follow-up in patients with single and multiple isolated subsegmental pulmonary embolism, respectively. No patients had a fatal recurrent pulmonary embolism. Limitation: The study was restricted to patients with low-risk subsegmental pulmonary embolism. Conclusion: Overall, patients with subsegmental pulmonary embolism who did not have proximal deep venous thrombosis had a higher-than-expected rate of recurrent venous thromboembolism. Primary Funding Source: Heart and Stroke Foundation of Canada and French Ministry of Health Programme Hospitalier de Recherche Clinique.