The clinical significance of pulmonary embolism (PE) limited to the subsegmental pulmonary arteries, so called isolated subsegmental pulmonary embolism (SSPE), remains controversial. Whether isolated SSPE represents "true" PE, a clinically more benign form of PE, a physiologic lung clearing process, or a false positive result (artifact) is currently unclear and hence, whether patients with isolated SSPE benefit from anticoagulant treatment is uncertain. Despite growing evidence from observational studies that withholding anticoagulation may be a safe option in selected patients with isolated SSPE (i.e., those without concomitant deep vein thrombosis, cancer, etc.), most patients with isolated SSPE receive anticoagulant treatment, which is associated with an increased risk of bleeding. The overall objective of the randomized controlled SAFE-SSPE trial is to evaluate the efficacy and safety of clinical surveillance without anticoagulation compared to anticoagulation treatment in low-risk patients with isolated SSPE.
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. Informed Consent as documented by signature
✓. Age ≥18 years
✓. Objective diagnosis of symptomatic or asymptomatic isolated SSPE
Exclusion criteria
✕. Presence of leg deep vein thrombosis (DVT) or upper extremity DVT (subclavian vein or above)
✕. Active cancer, defined as cancer treated with surgery, chemotherapy, radiotherapy, or palliative care during the last 6 months
✕. ≥1 prior episode of unprovoked VTE (absence of a transient or permanent risk factor)
✕. Clinical instability (systolic blood pressure \<100 mm Hg or arterial Oxygen saturation \<92% at ambient air) at the time of presentation
✕. Active bleeding or at high risk of bleeding
✕. Severe renal failure (creatinine clearance \<30ml/min)
✕. Severe liver insufficiency (Child-Pugh B or C)