How does your approach to subsegmental PE differ from segmental PE both diagnostically and therapeutically?

My approach to subsegmental PE and segmental PE generally tends to be very similar. I am aware of the CHEST guidelines which indicate patients can safely be observed with subsegmental PE, but like a recent study showed (Rouleau et al., PMID 37531107), uptake of these guidelines is slow and many patients are not eligible for structured surveillance rather than anticoagulation.

I would be curious who on theMednet has implemented structured surveillance into their clinical practice for subsegmental ...

Surveillance rather than anticoagulation for acute subsegmental PE was a mistake from the start. A large respected observational study published in Blood in 2013 showed similar outcomes and danger for subsegmental PE as more proximal PE (den Exter et al., PMID 23736701). The cohort study to test surveillance rather than treatment was ongoing while the erroneous CHEST guideline was issued. The cohort study took ten years to find and recruit just 292 eligible patients and found, in the authors' wo...

Hutchinson et al., PMID 26204274