Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation
Authors: Marc Carrier, Grégoire Le Gal
Journal: Annals of Internal Medicine (2022)

LettersApril 2022Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without AnticoagulationMarc Carrier, MD and Grégoire Le Gal, MD, PhDMarc Carrier, MDDepartment of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada and Grégoire Le Gal, MD, PhDCentre d'Investigation Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France, and Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0038 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We agree with Drs. Westafer and Vinson that our study does not close the chapter on the use of anticoagulation for subsegmental PE without proximal deep venous thrombosis. Confirmation of the diagnosis of subsegmental PE by an experienced thoracic radiologist remains a key component in the management of these patients. False-positive findings due to suboptimal vessel opacification can be caused by respiratory or heart pulsation artifacts, obesity, or mucus plug. Interobserver agreement between radiologists is low for the diagnosis of subsegmental PE in the emergency department, and many findings are reported as false-positive upon reinterpretation by a more ...References1. Pena E, Kimpton M, Dennie C, et al. Difference in interpretation of computed tomography pulmonary angiography diagnosis of subsegmental thrombosis in patients with suspected pulmonary embolism [Letter]. J Thromb Haemost. 2012;10:496-8. [PMID: 22212300] doi:10.1111/j.1538-7836.2011.04612.x CrossrefMedlineGoogle Scholar2. Ghanima W, Nielssen BE, Holmen LO, et al. Multidetector computed tomography (MDCT) in the diagnosis of pulmonary embolism: interobserver agreement among radiologists with varied levels of experience. Acta Radiol. 2007;48:165-70. [PMID: 17354136] CrossrefMedlineGoogle Scholar3. Roberge G, Carrier M. How to manage patients with symptomatic subsegmental pulmonary embolism. Pol Arch Intern Med. 2020;130:310-6. [PMID: 32091505] doi:10.20452/pamw.15211 CrossrefMedlineGoogle Scholar4. Kearon C, Ageno W, Cannegieter SC, et al; Subcommittees on Control of Anticoagulation, and Predictive and Diagnostic Variables in Thrombotic Disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14:1480-3. [PMID: 27428935] doi:10.1111/jth.13336 CrossrefMedlineGoogle Scholar5. Stevens SM, Woller SC, Baumann Kreuziger, et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160:2247-59. [PMID: 34352279] doi:10.1016/j.chest.2021.07.056 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaCentre d'Investigation Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France, and Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-2981. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation 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 , and Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation Lauren M. Westafer and David R. Vinson Metrics April 2022Volume 175, Issue 4Page: W43-W44KeywordsDeep vein thrombosisHemorrhageHospital medicinePulmonary arteriesPulmonary embolismResearch fundingThrombosisUltrasound imagingVascular medicineVenous thromboembolism ePublished: 19 April 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...