Researchers reviewed 896 CT pulmonary angiograms from 804 ICU patients between January 2019 and June 2025. Pulmonary embolism was identified in 164 examinations, while 104 patients had segmental or subsegmental embolism without a more proximal clot. Anticoagulation was given to 96% of this group and 86% of treated patients received therapeutic dosing. At 90 days, bleeding occurred in 15%, major bleeding in 12%, recurrent venous thromboembolism in 7.8% and mortality in 24%.
Key findings
- Therapeutic-dose anticoagulation was not significantly associated with 90-day mortality (adjusted OR 0.70; 95% CI 0.21–2.45), bleeding (OR 2.34; 95% CI 0.47–19.2) or recurrence (OR 0.69; 95% CI 0.11–6.22). The wide confidence intervals indicate substantial uncertainty and do not establish equivalence between treatment strategies.
Why this matters globally
Management of distal pulmonary embolism in critically ill patients remains an international evidence gap. This study contributes real-world outcome data and highlights the trade-off between bleeding and recurrence, but it is not sufficient by itself to change practice guidelines.
Thai researcher contribution
Thailand-linked authors Nuanprae Kitisin, Nattaya Raykateeraroj and Sikarin Upala are affiliated with Siriraj Hospital and Mahidol University. Affiliations and corresponding-author information were checked against bibliographic and publisher records.
Limitations to consider
The single-centre retrospective design is vulnerable to selection bias, treatment-by-indication confounding and incomplete clinical documentation. Limited event counts produced wide confidence intervals. The study cannot establish causality or prove benefit, harm or equivalence of therapeutic dosing.