Hot off the press Antithrombotic Therapy for VTE Disease: CHEST Guideline published in February 2016 addresses the clinical quagmire debated in this month’s show: Should we anticoagulate patients with subsegmental pulmonary embolism?
Based on level 2C evidence (which is more of a suggestion than edict) the guidelines recommend clinical surveillance over anticoagulation patients with subsegmental PE (no involvement of more proximal pulmonary arteries) and no proximal DVT in the legs who are at low risk for recurrent VTE. For high risk patients, they recommend anticoagulation.
Michael D., D.O. - March 11, 2016 10:03 AM
If an unprovoked DVT embolized and was small enough to be subsegmental, then are we recommending different treatments for the same condition?
Rob O - March 11, 2016 11:28 AM
Unprovoked clots, regardless of how big or small, are not considered low risk. One reason is that the unprovoked event is considered higher risk for recurrent or progressive venous thromboembolism.
Here is some of the text from the guideline...
we consider the following to be risk factors for recurrent or progressive VTE if patients are not anticoagulated -- patients who: are hospitalized or have reduced mobility for another reason; have active cancer (particularly if metastatic or being treated with chemotherapy); or have no reversible risk factor for VTE such as recent surgery.