Ikesaka R, Carrier M
Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
J Thromb Thrombolysis. 2015 Apr;39(3):311-4. doi: 10.1007/s11239-015-1169-7.
Computed tomographic pulmonary angiography (CTPA) has a high sensitivity for diagnosing filling defects in subsegmental pulmonary arteries. The adoption of CTPA as the preferred diagnostic modality for the diagnosis of pulmonary embolism (PE) has led to an increased rate of PE diagnosis. However, the case fatality rate is lower and the mortality rate of PE has remained unchanged despite this rise in PE diagnosis suggesting that the disease is of lesser severity. There continues to be clinical equipoise on whether patients diagnosed with isolated subsegmental PE (SSPE) require anticoagulation or can be managed conservatively if the presence of deep vein thrombosis (DVT) has been excluded. Recent recommendations from the European Society of Cardiology suggest an individualized approach for the management of patients with newly diagnosed SSPE based on the risk/benefit ratio of anticoagulation and the presence of lower limb DVT. Prospective data evaluating the safety and efficacy of management strategies for SSPE is needed in order to determine the optimal management of these patients.
计算机断层扫描肺动脉造影（CTPA）对诊断亚段肺动脉充盈缺损具有较高的敏感性。采用CTPA作为诊断肺栓塞（PE）的首选诊断方法导致PE诊断率上升。然而，尽管PE诊断率有所上升，但病死率较低，PE的死亡率保持不变，这表明该疾病的严重程度较低。对于诊断为孤立性亚段肺栓塞（SSPE）的患者，如果排除了深静脉血栓形成（DVT），是否需要抗凝治疗或可以采取保守治疗，临床上仍存在权衡。欧洲心脏病学会最近的建议表明，应根据抗凝的风险/获益比和下肢DVT的存在情况，对新诊断的SSPE患者采取个体化的管理方法。为了确定这些患者的最佳管理方案，需要评估SSPE管理策略安全性和有效性的前瞻性数据。
