Modern computed tomographic pulmonary angiography (CTPA) has excellent resolution and frequently detects distal, subsegmental pulmonary embolisms (SSPEs). These can be challenging to differentiate from artifact, and interobserver reliability is poor.1 Furthermore, the clinical significance of an isolated SSPE is questionable.2,3 For such cases, we determined how often clinicians opted for clinical surveillance over therapeutic anticoagulation in our center.
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All patients who receive anticoagulation therapy are at risk for adverse events. Pulmonary embolism is a "non second chance condition" for the patient. The co-morbidity that put the patient at risk of developing pulmonary embolism must also be considered.
Some patients with pulmonary embolism who have late complications from anticoagulation therapy might have been dead if they had not had the opportunity to survive through this treatment. Caution in using anticoagulation therapy in some patients with pulmonary embolism must be balanced against providing the patient with the best chance to continue to fight to survive.
Raslan IA, Chong J, Gallix B, Lee TC, McDonald EG. Rates of Overtreatment and Treatment-Related Adverse Effects Among Patients With Subsegmental Pulmonary Embolism. JAMA Intern Med. 2018;178(9):1272–1274. doi:10.1001/jamainternmed.2018.2971
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