Department of General Internal Medicine, Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise, Université Laval, Québec, Canada.
Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
Thromb Res. 2021 Jan;197:77-83. doi: 10.1016/j.thromres.2020.10.033. Epub 2020 Nov 6.
Cancer therapy and progress in quality of imaging technologies for cancer surveillance and staging are in cause for the increase incidence of smaller incidental pulmonary embolism (PE). The clinical significance of incidental subsegmental pulmonary embolism (SSPE) is hard to define, balancing between possible false positive result, hypercoagulability signal, and truly venous thromboembolism (VTE) event. Evidence for optimal management of such findings are largely extrapolated from symptomatic SSPE in non-cancer patients and from symptomatic, more proximal PE in cancer patients. Current practice guidelines vary but some suggest withholding anticoagulation in selected patients. However, most SSPEs, incidental or not, should be treated as any other cancer-associated PE due to likely similar prognosis. Choice and duration of anticoagulation are extended from existing knowledge on more proximal PE.
癌症治疗以及癌症监测和分期成像技术的进步导致较小的偶发性肺栓塞（PE）的发病率上升。偶发性亚段性肺栓塞（SSPE）的临床意义难以确定，需要在可能的假阳性结果、高凝状态信号和真正的静脉血栓栓塞（VTE）事件之间取得平衡。对于这些发现的最佳管理证据主要是从非癌症患者的有症状 SSPE 和癌症患者的有症状、更接近近端的 PE 中推断出来的。目前的实践指南有所不同，但有些建议在选定的患者中避免抗凝治疗。然而，由于可能相似的预后，大多数 SSPE，无论是偶发性还是非偶发性，都应视为任何其他与癌症相关的 PE 进行治疗。抗凝的选择和持续时间是根据对更接近近端的 PE 的现有知识进行扩展的。
