More Evidence Not to Anticoagulate Patients with Isolated Subsegmental Pulmonary Embolism

While traditional practice mandated anticoagulation for all pulmonary emboli (PE) regardless of size, more-recent guidelines suggest the possibility of not anticoagulating patients with isolated subsegmental PE (those without associated deep venous thromboses). These guidelines and the potential for avoidance of anticoagulation were discussed in a recent NEJM Journal Watch Clinical Spotlight (NEJM JW Emerg Med Jul 2018). To add to the data informing these decisions, researchers retrospectively reviewed the treatment, outcomes, and complications of anticoagulation in patients with PE at a tertiary care hospital in Montreal from 2014 to 2016.

Of 222 patients with PE, 71 (32%) had isolated subsegmental PE, and of these, 62 (87%) received antico…