Authors highlight that patients had received anticoagulation for potentially insignificant emboli, often in the presence of terminal illness.
A related editorial discusses this research. In patients believed to have a true, clinically relevant SSPE (without DVT, which would warrant treatment), the decision to anticoagulate should be based on an assessment of the patient’s risk of recurrence, cardiopulmonary reserve, and risk of bleeding. In low-risk patients with adequate reserve, or in patients with high bleeding risk, clinical surveillance is favoured. Factors that might lead to the decision to anticoagulate include the presence of active malignant neoplasm, idiopathic clot, marked symptoms, or patient preference. Although the majority of the cohort of patients that this study reported on predated the publication of recent guidelines advocating this conservative approach, the data nonetheless highlight the issue of overtreatment of SSPE and the potential harm associated with it.