Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Hamostaseologie. 2024 Jun;44(3):197-205. doi: 10.1055/a-2163-3111. Epub 2023 Oct 23.
Subsegmental pulmonary embolism (SSPE) is increasingly diagnosed with the growing use and technological advancements of multidetector computed tomography pulmonary angiography. Its diagnosis is challenging, and some presumed SSPE may actually represent imaging artifacts. Indirect evidence and results from small observational studies suggest that SSPE may be more benign than more proximal pulmonary embolism, and may thus not always require treatment. Therefore, guidelines suggest to consider a management strategy without anticoagulation in selected patients with SSPE at low risk of recurrent venous thromboembolism (VTE), in whom proximal deep vein thrombosis is excluded. Recently, a large prospective study among low-risk patients with SSPE who were left untreated showed a higher VTE recurrence risk than initially deemed acceptable by the investigators, and thus was prematurely interrupted after recruitment of 97% of the target population. However, the risk-benefit ratio of anticoagulation for low-risk patients with SSPE remains unclear, and results from randomized trials are needed to answer the question about their optimal management.
亚段肺栓塞（SSPE）随着多排螺旋 CT 肺动脉造影的广泛应用和技术进步，其检出率逐渐增加。但 SSPE 的诊断具有挑战性，一些疑似 SSPE 实际上可能代表影像学伪影。来自小型观察性研究的间接证据和结果表明，SSPE 可能比更靠近段的肺栓塞更具良性，因此并非总是需要治疗。因此，指南建议在排除近端深静脉血栓形成的情况下，对于低复发静脉血栓栓塞（VTE）风险的 SSPE 低危患者，考虑采用不抗凝的管理策略。最近，一项针对 SSPE 低危患者的大型前瞻性研究显示，未治疗组的 VTE 复发风险高于研究人员最初认为可接受的水平，因此在目标人群招募完成 97%后提前中断。然而，SSPE 低危患者抗凝的风险获益比仍不清楚，需要随机临床试验的结果来回答关于其最佳管理的问题。
