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Single versus multiple and incidental versus symptomatic subsegmental pulmonary embolism: clinical characteristics and outcome

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Abstract

It remains unexplored if the clinical picture and outcome of subsegmental pulmonary embolism (SSPE) differ between single versus multiple, and incidental versus symptomatic embolism. Consecutive patients anticoagulated for SSPE at the Mayo Thrombophilia Clinic (03/01/2013–12/31/2020) were followed forward to assess venous thromboembolism (VTE) recurrence, mortality, major bleeding, and clinically relevant non-major bleeding (CRNMB); expressed as a rate per 100 person-years. Among 3878 VTE patients, 1541 had pulmonary embolism including 224 (14.6%) with SSPE either single (n = 139) or multiple (n = 85; 46 bilateral and 39 unilateral emboli); 134 had incidental and 90 symptomatic SSPE. Patients with single were less often symptomatic and less often had coexisting DVT than multiple SSPE. Patients with incidental had a two-fold higher frequency of cancer compared to symptomatic SSPE. During the study period, 1 patient with single and 2 with multiple SSPE had VTE recurrence (rate of 1.14 vs 3.63, p = 0.280). Single SSPE patients experienced 2 episodes of major bleeding (rate of 2.36) while the multiple SSPE group had no major bleeding. Seven patients in each group had CRNMB events (rate of 8.20 vs 13.58 for single and multiple SSPE, respectively, p = 0.282). Patients with single SSPE had a higher death rate compared to multiple SSPE (43.07 vs 22.22, p = 0.031) but no difference was noted after adjusting for cancer (p = 0.388). Also, incidental had similar clinical outcomes to symptomatic SSPE.

Interpretation Anticoagulated SSPE patients with single and multiple as well as incidental and symptomatic have a different clinical profile but similar clinical outcomes.

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All stored at designated REDCap.

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ClinicalTrials.gov: NCT03504007.

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Funding

This work was supported by discretionary funds from the Gonda Vascular Center, Mayo Clinic Rochester.

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Authors and Affiliations

  1. Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA

    Yumiko Hirao-Try, Danielle T. Vlazny, Ryan Meverden, Damon E. Houghton, Ana I. Casanegra, David A. Froehling, Lisa G. Peterson, Robert D. McBane & Waldemar E. Wysokinski

  2. Gonda Vascular Center, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA

    Yumiko Hirao-Try, Danielle T. Vlazny, Ryan Meverden, Damon E. Houghton, Ana I. Casanegra, David A. Froehling, Lisa G. Peterson, Robert D. McBane & Waldemar E. Wysokinski

  3. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, FL, USA

    David O. Hodge

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  1. Yumiko Hirao-Try
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  2. Danielle T. Vlazny
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  5. Ana I. Casanegra
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  7. David O. Hodge
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  9. Robert D. McBane
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  10. Waldemar E. Wysokinski
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Correspondence to Waldemar E. Wysokinski.

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Hirao-Try, Y., Vlazny, D.T., Meverden, R. et al. Single versus multiple and incidental versus symptomatic subsegmental pulmonary embolism: clinical characteristics and outcome. J Thromb Thrombolysis 54, 82–90 (2022). https://doi.org/10.1007/s11239-021-02623-z

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  • DOI: https://doi.org/10.1007/s11239-021-02623-z

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