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Abstract
[...]the term massive PE is actually a hemodynamic definition and refers to any PE that presents with shock and hemodynamic collapse.12 Thus, it is incorrect to refer to patients with saddle PE as having massive PE because every clinician has encountered patients with saddle PE who present with stable hemodynamic values and a very benign clinical picture. [...]saddle PE is a diverse entity with variable clinical features and eventual outcomes. Patients with saddle PE were also more likely to be diagnosed as having a lower-extremity DVT and were twice as likely to undergo IVC filter placement. [...]patients with saddle PE seem to have some specific in-hospital morbidity risks but not necessarily a higher mortality rate. [...]20% of patients with nonsaddle PE also presented with massive PE features despite the fact that two-thirds of them had anatomic clot burden only in a segmental/subsegmental location. Patients with saddle PE do seem to have higher rates of DVT and a higher risk of late decompensation. [...]optimal clinical management of patients with saddle PE should be based on the initial and delayed hemodynamic status rather than on the location and extent of the anatomic clot burden.