Abstract
Background Current guidelines suggest treating cancer patients with incidental pulmonary embolism (PE) similarly to those with clinically suspected and confirmed PE. However, the natural history of these presentations has not been thoroughly compared.
Methods We used the data from the RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry to compare the 3-month outcomes in patients with active cancer and incidental PE versus those with clinically suspected and confirmed PE. The primary outcome was 90-day all-cause mortality. Secondary outcomes were PE-related mortality, symptomatic PE recurrences and major bleeding.
Results From July 2012 to January 2019, 946 cancer patients with incidental asymptomatic PE and 2274 with clinically suspected and confirmed PE were enrolled. Most patients (95% versus 90%) received low-molecular-weight heparin therapy. During the first 90 days, 598 patients died, including 42 from PE. Patients with incidental PE had a lower all-cause mortality rate than those with suspected and confirmed PE (11% versus 22%; OR 0.43, 95% CI 0.34–0.54). Results were consistent for PE-related mortality (0.3% versus 1.7%; OR 0.18, 95% CI 0.06–0.59). Multivariable analysis confirmed that patients with incidental PE were at lower risk of death (adjusted OR 0.43, 95% CI 0.34–0.56). Overall, 29 (0.9%) patients developed symptomatic PE recurrences, and 122 (3.8%) had major bleeding. There were no significant differences in PE recurrences (OR 0.62, 95% CI 0.25–1.54) or major bleeding (OR 0.78, 95% CI 0.51–1.18).
Conclusions Cancer patients with incidental PE had a lower mortality rate than those with clinically suspected and confirmed PE. Further studies are required to validate these findings, and to explore optimal management strategies in these patients.
Abstract
In cancer patients with incidental pulmonary embolism the risk of venous thromboembolism recurrences or major bleeding are similar, with a lower mortality https://bit.ly/36AVqSy
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.04630-2020
Coordinator of the RIETE Registry: Manuel Monreal. RIETE Steering Committee Members: Paolo Prandoni, Benjamin Brenner and Dominique Farge-Bancel. RIETE National Coordinators: Raquel Barba (Spain), Pierpaolo Di Micco (Italy), Laurent Bertoletti (France), Sebastian Schellong (Germany), Inna Tzoran (Israel), Abilio Reis (Portugal), Marijan Bosevski (Republic of Macedonia), Henri Bounameaux (Switzerland), Radovan Malý (Czech Republic), Peter Verhamme (Belgium), Joseph A. Caprini (USA) and Hanh My Bui (Vietnam). RIETE Registry Coordinating Center: S&H Medical Science Service. Members of the RIETE Group: Spain: Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Aramberri M, Arcelus JI, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón-Andrés B, Blanco-Molina A, Camon AM, Cañas I, Cerdà P, Criado J, de Ancos C, de Miguel J, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche MC, Díaz-Peromingo JA, Díez-Sierra J, Domínguez IM, Encabo M, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Fernández de Roitegui K, Fidalgo MA, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, García MA, García-Bragado F, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Gayol MC, Gil-Díaz A, Gómez-Cuervo C, González-Martínez J, Grau E, Gutiérrez J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Núñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Manrique-Abos I, Marchena PJ, Martín-Asenjo M, Martín-Fernández M, Martín-Guerra JM, Martín-Martos F, Mellado M, Mercado MI, Moisés J, Monreal M, Morales MV, Muñoz-Blanco A, Muñoz-Guglielmetti D, Nieto JA, Núñez MJ, Olivares MC, Ortega-Recio MD, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Pérez-Jacoíste MA, Peris ML, Pesántez D, Porras JA, Portillo J, Ramos E, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Fernández L, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, Rubio CM, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Sanmartín R, Soler S, Suárez S, Suriñach JM, Tiberio G, Tolosa C, Torres MI, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Villares P, Zamora C. Argentina: Gutiérrez P, Vázquez FJ. Belgium: Vanassche T, Vandenbriele C, Verhamme P. Czech Republic: Hirmerova J, Malý R. Ecuador: Salgado E. France: Benzidia I, Bertoletti L, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G. Germany: Schellong S. Israel: Braester A, Brenner B, Tzoran I. Italy: Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Maida R, Mangiacapra S, Mastroiacovo D, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Ventresca A, Visonà A, Vo Hong N, Zalunardo B. Latvia: Kigitovica D, Make K, Skride A. Portugal: Ferreira M, Meireles J. Republic of Macedonia: Bosevski M, Zdraveska M. Switzerland: Bounameaux H, Mazzolai L. USA: Bikdeli B, Caprini JA, Tafur AJ, Weinberg I, Wilkins H. Vietnam: Bui HM.
Author contributions: M. Peris, J.J. López-Nuñez, A. Maestre, D. Jiménez, B. Bikdeli and M. Monreal designed the study, collected the data, analysed the data, commented on the results, wrote the draft and revised the final version of the paper. All the authors collected the data, had full access to the data, comment the results and revised the final version of the paper.
Conflict of interest: M. Peris has nothing to disclose.
Conflict of interest: J.J. López-Nuñez has nothing to disclose.
Conflict of interest: A. Maestre has nothing to disclose.
Conflict of interest: D. Jiménez has nothing to disclose.
Conflict of interest: A. Muriel has nothing to disclose.
Conflict of interest: B. Bikdeli is a consulting expert, on behalf of the plaintiff, for litigation related to a specific type of IVC filter.
Conflict of interest: I. Weinberg has nothing to disclose.
Conflict of interest: C. Ay has nothing to disclose.
Conflict of interest: L. Mazzolai has nothing to disclose.
Conflict of interest: A. Lorenzo has nothing to disclose.
Conflict of interest: M. Monreal has nothing to disclose.
Support statement: This work was supported by Sanofi España. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received July 10, 2020.
- Accepted November 30, 2020.
- Copyright ©ERS 2021
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