Fernández-Capitán Carmen, Rodriguez Cobo Ana, Jiménez David, Madridano Olga, Ciammaichella Maurizio, Usandizaga Esther, Otero Remedios, Di Micco Pierpaolo, Moustafa Farès, Monreal Manuel
Department of Internal Medicine Hospital Universitario La Paz Madrid Spain.
Department of Internal Medicine Hospital de Madrid Norte Sanchinarro Madrid Spain.
Res Pract Thromb Haemost. 2020 Nov 18;5(1):168-178. doi: 10.1002/rth2.12446. eCollection 2021 Jan.
The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial.
We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs.
Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low-molecular-weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16-3.85) or more central PE (HR, 1.89; 95% CI, 1.12-3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02-3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging.
Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.
急性亚段肺栓塞（PE）患者的最佳治疗方法存在争议。
我们使用RIETE（静脉血栓栓塞疾病信息登记库）数据库，比较亚段、段或更中心性PE患者抗凝治疗期间症状性PE复发率。
在15963例首次发生症状性PE的患者中，834例（5.2%）为亚段PE，3797例（24%）为段PE，11332例（71%）为更中心性PE。所有亚组中的大多数患者初始接受低分子量肝素治疗，然后大多数转换为维生素K拮抗剂。治疗的中位持续时间分别为179天、185天和204天。抗凝治疗期间，183例患者发生PE复发，131例发生深静脉血栓形成（DVT），543例出血，1718例死亡（致命性PE，135例）。亚段PE患者的PE复发率比段PE（风险比[HR]，2.13；95%置信区间[CI]，1.16 - 3.85）或更中心性PE患者（HR，1.89；95%CI，1.12 - 3.13）高出两倍。多变量分析显示，亚段PE患者的PE复发风险高于中心性PE患者（校正HR，1.75；95%CI，1.02 - 3.03）。根据下肢超声成像对亚段PE患者进行分层后，DVT患者、无DVT患者和未进行超声成像患者的PE复发率相似。
我们的研究表明，段PE患者的PE复发风险并不低于更中心性PE患者，因此提示PE复发风险不受PE解剖位置的影响。
