Clinical Surveillance vs. Anticoagulation for Low-risk Patients With Isolated Subsegmental Pulmonary Embolism

  • STATUS
    Recruiting
  • participants needed
    276
  • sponsor
    Drahomir Aujesky
Updated on 19 February 2024
cancer
anticoagulation therapy
anticoagulants
rivaroxaban
anticoagulant
thrombosis
deep vein thrombosis
pulmonary embolism
venous thromboembolism
thromboembolism
embolism
lung diseases
cardiovascular diseases
anticoagulation treatment
sspe
diseases venous

Summary

The clinical significance of pulmonary embolism (PE) limited to the subsegmental pulmonary arteries, so called isolated subsegmental pulmonary embolism (SSPE), remains controversial. Whether isolated SSPE represents "true" PE, a clinically more benign form of PE, a physiologic lung clearing process, or a false positive result (artifact) is currently unclear and hence, whether patients with isolated SSPE benefit from anticoagulant treatment is uncertain. Despite growing evidence from observational studies that withholding anticoagulation may be a safe option in selected patients with isolated SSPE (i.e., those without concomitant deep vein thrombosis, cancer, etc.), most patients with isolated SSPE receive anticoagulant treatment, which is associated with an increased risk of bleeding. The overall objective of the randomized controlled SAFE-SSPE trial is to evaluate the efficacy and safety of clinical surveillance without anticoagulation compared to anticoagulation treatment in low-risk patients with isolated SSPE.

Details
Condition Pulmonary Disease, Embolism and Thrombosis, Hemorrhage, Hemorrhage, Embolism, Vascular Diseases, Vascular Diseases, Venous Thromboembolism, Venous Thromboembolism, Respiratory Tract Diseases, Pulmonary Embolism, Pulmonary Embolism, Cardiovascular Disease, Thromboembolism, Thromboembolism, Anticoagulant-induced Bleeding
Age 18-100 years
Treatment Placebo, Rivaroxaban
Clinical Study IdentifierNCT04263038
SponsorDrahomir Aujesky
Last Modified on19 February 2024

Eligibility

Yes No Not Sure

Inclusion Criteria

Informed Consent as documented by signature
Age 18 years
Objective diagnosis of symptomatic or asymptomatic isolated SSPE

Exclusion Criteria

Presence of leg deep vein thrombosis (DVT) or upper extremity DVT (subclavian vein or above)
Active cancer, defined as cancer treated with surgery, chemotherapy, radiotherapy, or palliative care during the last 6 months
1 prior episode of unprovoked VTE (absence of a transient or permanent risk factor)
Clinical instability (systolic blood pressure <100 mm Hg or arterial Oxygen saturation <92% at ambient air) at the time of presentation
Active bleeding or at high risk of bleeding
Severe renal failure (creatinine clearance <30ml/min)
Severe liver insufficiency (Child-Pugh B or C)
Concomitant use of strong CYP3A4 inhibitors or strong CYP3A4 inducers
Known hypersensitivity to rivaroxaban
Need for therapeutic anticoagulation for another reason
Therapeutic anticoagulation for >72 hours for any reason at the time of screening
Hospitalized for >72 hours prior to the diagnosis of isolated SSP (hospital-acquired VTE)
Known pregnancy or breast feeding (pregnancy test to be performed for women of childbearing potential)
Lack of safe contraception in women of childbearing potential
Refusal or inability to provide informed consent
Prior enrolment in this trial
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