LAUSR

Advances in the technology of diagnostic modalities for the diagnosis of pulmonary embolism (PE) have led to a rise in the incidence of this disease. Some studies report a decrease in the case-fatality rate of PE without any changes in the mortality rate suggesting potential overdiagnosis. It is thought that this increase in rate of PE diagnosis is due to an incremental diagnosis of smaller, less severe PE of unknown clinical significance. Potentially higher rates of false positive results are also an important clinical concern. Low quality evidences have suggested that these subsegmental pulmonary embolism (SSPE) may be safely managed without initiating anticoagulation, but other studies have not. Based on individualized risk-benefit ratio, current clinical practice guidelines suggest that a selected group of patients with SSPE deemed to be at low risk of recurrence and without concomitant DVT on serial bilateral leg ultrasound might benefit from clinical surveillance instead of anticoagulation. This approach is currently assessed prospectively in an on-going prospective cohort study.