Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation
Carmen Fernández‐Capitán, Ana Rodríguez Cobo, David Jiménez, Olga Madridano, Maurizio Ciammaichella, Esther Usandizaga, Remedios Otero, Pierpaolo Di Micco, Farès Moustafa, Manuel Monréal, María Dolores Adarraga, Miguel Ángel Aibar Arregui, M. Alfonsa, Juan I. Arcelus, Pedro María Azcárate-Agüero, Aitor Ballaz, Pedro A. Parra Baños, Raquel Barba, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, Á. Blanco-Molina, A.M. Camón, Leyre Chasco, A.J. Cruz, Roberto del Pozo, Javier de Miguel‐Díez, J. del Toro, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, J.C. Escribano, C. Falgá, C. Fernández‐Aracil, M.A. Fidalgo, Carme Font, Llorenç Font, Marian García-Núñez, F. García‐Bragado, Marcial García-Morillo, Aránzazu García‐Raso, Aldara García‐Sánchez, O. Gavín, I. Gaya, Cristina Gómez, V. Gómez, J. González, E Grau, Ricardo Guijarro, Javier Gutiérrez, G. Hernández-Comes, L. Hernández‐Blasco, E. Rocha Hernando, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, M.D. Joya, J. Lima, Pilar Llamas, J.L. Lobo, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, M. Lumbierres, Ana Maestre, Pablo Javier Marchena, F. Martín‐Martos, Mercedes Martı́n-Romero, M.V. Morales, José Antonio Nieto, Santiago Nieto, Antonio Rodríguez‐Núñez, Manuel Jesús Núñez, M. Odriozola, M.C. Olivares, S. Otálora, José María Pedrajas, Galadriel Pellejero, C. Pérez‐Ductor, M.L. Peris, I. Pons, José Antonio Porras, L. Ramírez, Òscar Reig, Antoni Riera‐Mestre, David Riesco, A. Rivas, M.A. Rodríguez‐Dávila, V. Rosa, Pedro Ruiz‐Artacho, Joan Carles Sahuquillo, M.C. Sala‐Sainz, A. Sampériz, R. Sánchez‐Martínez, S. Soler, B. Sopeña, José María Suriñach, Carlos Tolosa, Marı́a Isabel Torres, José M. Troya
Abstract
BACKGROUND: The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial. METHODS: We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. RESULTS: Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. CONCLUSIONS: Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.