Clinical question: Should patients with subsegmental pulmonary embolism be anticoagulated?
Background: A recent CHEST clinical guideline suggests it is reasonable to withhold anticoagulation for subsegmental pulmonary embolism. This has been a topic of controversy given the lack of a systematic review.
Study design: Systematic review and meta-analysis.
Setting: A comprehensive literature search was performed by a medical librarian in Ovid, MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar.
Synopsis: After 1,512 papers were screened, 14 studies were included in the review and analysis. Primary outcomes were frequency of bleeding, venous thromboembolism recurrence, and death for patients with subsegmental pulmonary embolism with and without treatment. Because of a lack of precision in pooled data and high heterogeneity of outcomes, no inferences could be made about benefit or harm with either approach.
The conclusions were limited because of the small numbers, imprecision, and lack of controlled trials. There is a need for a randomized controlled trial regarding subsegmental pulmonary embolism.
Bottom line: The decision to treat or not treat a patient with subsegmental pulmonary embolism should be done based on clinical judgment and a shared decision-making model with the patient.
Citation: Bariteau A et al. Systematic review and meta-analysis of outcomes of patients with subsegmental pulmonary embolism with and without anticoagulation treatment. Acad Emerg Med. 2018 Mar 2.
Dr. Chadha is an assistant professor in the division of hospital medicine at the University of Kentucky, Lexington.