{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T05:51:28Z","timestamp":1783749088304,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,9,4]],"date-time":"2022-09-04T00:00:00Z","timestamp":1662249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the impact of clinical context on anticoagulation and outcomes of SSPE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We electronically searched computed tomography pulmonary angiogram reports to identify SSPE. We extracted demographic, risk factor, investigations and outcome data from the electronic medical record. We stratified patients according to anticoagulation and no anticoagulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1 January 2017 to 31 December 2019, we identified 166 patients with SSPE in 5827 pulmonary angiogram reports. Of these, 123 (74%) received anticoagulation. Compared with non\u2010anticoagulated patients, such patients had a different clinical context: higher rates of previous venous thromboembolism (11% vs 0%; <jats:italic>P =<\/jats:italic> 0.019), more recent surgery (26% vs 9%; <jats:italic>P =<\/jats:italic> 0.015), more elevated serum D\u2010dimer (22% vs 5%; <jats:italic>P =<\/jats:italic> 0.004), more lung parenchymal abnormalities (76% vs 61%; <jats:italic>P =<\/jats:italic> 0.037) and were almost twice as likely to require inpatient care (76% vs 42%; <jats:italic>P<\/jats:italic> &lt;\u20090.001). Such patients also had twice the all\u2010cause mortality at 1\u2009year (32% vs 16%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15789","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T06:08:42Z","timestamp":1651471722000},"page":"1435-1443","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Subsegmental pulmonary embolism and anticoagulant therapy: the impact of clinical context"],"prefix":"10.1111","volume":"53","author":[{"given":"Ariel","family":"Dahan","sequence":"first","affiliation":[{"name":"Department of Radiology Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2468-8287","authenticated-orcid":false,"given":"Sergio","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Haematology Royal Hobart Hospital  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8501-4054","authenticated-orcid":false,"given":"Natasha E.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Data Analytics Research and Evaluation Austin Hospital and University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Kachel","sequence":"additional","affiliation":[{"name":"Department of Radiology Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine F.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Austin Hospital, University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Marhoon","sequence":"additional","affiliation":[{"name":"Data Analytics Research and Evaluation Austin Hospital and University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumitaka","family":"Yanase","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinaldo","family":"Bellomo","sequence":"additional","affiliation":[{"name":"Data Analytics Research and Evaluation Austin Hospital and University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Intensive Care Austin Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2007.02450.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.02.024"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.14.1711"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.01.041"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14769"},{"key":"e_1_2_7_7_1","volume-title":"The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism","author":"Office of the Surgeon General (US); National Heart, Lung, and Blood Institute (US)","year":"2008"},{"key":"e_1_2_7_8_1","unstructured":"ThompsonBT &KabrhelCOverview of acute pulmonary embolism in adults.UpToDate; 2018 [updated 2020 Jun 9; cited 2020 May 21]. Available from URL:https:\/\/www.uptodate.com\/contents\/overview-of-acute-pulmonary-embolism-in-adults?search=pulmonaryembolism&amp;source=search_result&amp;selectedTitle=1~150&amp;usage_type=default&amp;display_rank=1"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01647-2019"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.07.055"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.03938.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.178"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02841850601100859"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMclde1907665"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.10.033"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-04-497545"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13399"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.04.040"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.12.030"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00101-015-0118-3"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2012.04647.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.12.8624"},{"key":"e_1_2_7_23_1","first-page":"539","article-title":"Wells score and poor outcomes among adult patients with subsegmental pulmonary embolism: a cohort study","volume":"21","author":"Angriman F","year":"2015","journal-title":"Sage"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2010.07.001"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12803"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2341031880"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-2981"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15531"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12507"},{"issue":"2","key":"e_1_2_7_30_1","article-title":"Solitary versus multiple subsegmental pulmonary emboli: clinical characteristics and outcomes [abstract]","volume":"5","author":"Hirao\u2010try Y","year":"2021","journal-title":"Res Pract Thromb Haemost"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.15789","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.15789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:43:17Z","timestamp":1752756197000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.15789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,4]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/imj.15789"],"URL":"https:\/\/doi.org\/10.1111\/imj.15789","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,4]]},"assertion":[{"value":"2022-01-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}