Symptomatic subsegmental versus more central pulmonary embolism: Clinical outcomes during anticoagulation

The RIETE Investigators

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)168-178
Number of pages11
JournalResearch and Practice in Thrombosis and Haemostasis
Issue number1
StatePublished - Jan 2021

Bibliographical note

Funding Information:
The authors thank Sanofi Spain for supporting this registry with an unrestricted educational grant and Bayer Pharma AG for supporting this registry. Bayer Pharma AG's support was limited to the part of RIETE outside Spain, which accounts for 24.05% of the total patients included in the RIETE Registry. The authors also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data and logistic and administrative support; and Prof. Salvador Ortiz, Universidad Autónoma de Madrid, and Silvia Galindo, both statistical advisors in S&H Medical Science Service for the statistical analysis of the data presented in this article.

Publisher Copyright:
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).


  • anticoagulant
  • deep vein thrombosis
  • outcomes
  • pulmonary embolism
  • subsegmental


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