Is it true that 79% of recurrent pulmonary embolisms are fatal, and what is the definition of a recurrent pulmonary embolism?

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Last updated: November 14, 2026 • View editorial policy

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No, 79% of recurrent PEs are NOT universally fatal—this figure comes from a specific 2007 study and does not represent the overall mortality of all recurrent pulmonary embolisms.

What is a Recurrent Pulmonary Embolism?

A recurrent PE is a new pulmonary embolism that occurs after the initial (index) PE event has been diagnosed and treated. This can happen either:

  • During anticoagulation treatment
  • After anticoagulation has been discontinued
  • As a new symptomatic event confirmed by objective imaging (CT pulmonary angiography or ventilation-perfusion scan)

The key distinction is that it represents a new thromboembolic event, not persistence or progression of the original clot.

Understanding the 79% Fatality Statistic

The 79% figure you're referencing comes from a single 2007 prospective cohort study 1. This statistic is highly misleading when taken out of context:

  • In that study, only 20 out of 673 patients (3.0%) developed recurrent VTE over 3 months
  • Of those 20 recurrences, 14 were recurrent PEs
  • Of those 14 recurrent PEs specifically, 11 were fatal (79%)
  • Critically, most of these fatal recurrent PEs occurred within the first week after the initial PE diagnosis 1

This does NOT mean that 79% of all recurrent PEs are fatal across all populations and timeframes.

What is the Actual Mortality Risk?

The mortality from recurrent PE varies dramatically based on timing and patient characteristics:

Early Recurrence (First Days to Weeks)

  • Carries the highest mortality risk
  • Most fatal recurrent PEs occur within the first 10 days of initial diagnosis 2
  • In one study, 39 of 48 recurrent PEs occurred within 10 days, with 36 being fatal 2

Late Recurrence (After 6 Months)

  • Much lower mortality risk
  • One study found only 2 non-fatal recurrent PEs between 6-12 months 2
  • The person-time rate of death from recurrent thromboembolism 6-60 months after the initial event was only 0.16% in younger patients 3

Overall Context from Guidelines

The 2019 ESC Guidelines provide crucial perspective: When patients who previously had a PE experience VTE recurrence, it more frequently manifests as PE (rather than DVT). As a consequence, the case fatality rate of recurrent VTE in patients who previously had PE is twice as high as VTE recurrence after DVT 4. However, this does NOT translate to a 79% mortality rate.

Key Clinical Implications

The critical takeaway is that recurrent PE risk and mortality are highest in the immediate post-diagnosis period:

  • Risk factors for recurrent VTE include: immobilization >3 days, being an inpatient, malignancy, and cardiopulmonary comorbidities 1
  • All patients with PE should receive >3 months of anticoagulant treatment 4
  • Extended anticoagulation reduces recurrent VTE risk by approximately 90%, though this must be balanced against bleeding risk 4

For patients at high risk of recurrence (>8% per year): Those with active cancer, unprovoked PE, previous VTE episodes, or antiphospholipid syndrome warrant consideration for extended or indefinite anticoagulation 4

Common Pitfall

Do not use the 79% figure to counsel patients about their overall risk of dying from recurrent PE. This creates unnecessary alarm and misrepresents the actual risk, which is:

  • Highest in the first week (when most patients are still hospitalized and anticoagulated)
  • Much lower after the acute phase
  • Highly dependent on individual risk factors and adequate anticoagulation

The overall 3-month rate of symptomatic or fatal recurrent VTE in appropriately treated low-risk PE patients can be as low as 0.6% 4.

References

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