Key result
Active cancer in patients with pulmonary embolism was associated with a significantly higher risk of recurrent venous thromboembolism and PE-related death compared to non-cancer PE (adjusted HR 9.75).
Why the study?
Although acute pulmonary embolism adversely impacts survival and requires treatment regardless of cancer, the treatment rate of cancer-related pulmonary embolism is relatively low.
Does the presence of active cancer worsen the clinical outcomes of pulmonary embolism in patients with newly diagnosed PE?
Observational (n=976)
No
Does the presence of active cancer worsen the clinical outcomes of pulmonary embolism in patients with newly diagnosed PE?
Hazard Ratio: 9.75 (95% CI 2.4–39.2)
Absolute Event Rate: 14.4% vs 6.6%
p-value: p=0.001
Cancer-related pulmonary embolism presents with less severe initial clinical manifestations but is associated with a significantly higher risk of recurrent VTE and PE-related death compared to non-cancer PE, highlighting the need for active anticoagulation.
May warrant closer surveillance in cancer-associated PE; leaves open whether intensified anticoagulation improves outcomes in this observational cohort.
BACKGROUND/AIMS: Although acute pulmonary embolism (PE) adversely impacts survival and should be treated regardless of cancer, the treatment rate of cancer-related PE is relatively low. We aimed to compare clinical characteristics and long term prognosis of PE in patients with or without cancer. METHODS: From March 2010 to December 2013, patients with newly diagnosed PE were analyzed. Baseline demographics, comorbidities, cancer status and clinical manifestations of PE were recorded. We defined primary composite outcome as recurrent venous thromboembolism (VTE) and death from PE. RESULTS: Among a total of 976 patients with PE, the 703 (72.0%) had cancer-related PE. Cancer-related PE group was more frequently asymptomatic (54.5% vs. 13.2%, p < 0.001), less extensive (involvement of bilateral pulmonary arteries: 42.8% vs. 51.3%, p = 0.017; lung infarction: 5.3% vs. 10.3%, p = 0.005) and less likely to accompany right ventricular dysfunction (10.3% vs. 27.2%, p < 0.001) compared with the non-cancer PE group. Anticoagulation was less frequently underwent in patients with cancer-related PE than those without cancer (62.0% vs. 81.7%, p < 0.001). A composite of recurrent VTE and death from PE was significantly higher in the cancer-related PE group (14.4% vs. 6.6%, p = 0.001). CONCLUSION: Although PE in cancer patients were seem to be less aggressive initially, compared to those without cancer, they had significantly poor prognosis. Given a high rate of recurrent VTE and relatively similar risk of anticoagulation associated bleeding events in cancer patients, more active treatment of PE is warranted in cancer patients.
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Kim et al. (2019) conducted an observational in Pulmonary embolism (n=976). Active cancer vs. No active cancer was evaluated on Composite of recurrent venous thromboembolism and death from pulmonary embolism (HR 9.75, 95% CI 2.4-39.2, p=0.001). Active cancer in patients with pulmonary embolism was associated with a significantly higher risk of recurrent venous thromboembolism and PE-related death compared to non-cancer PE (adjusted HR 9.75).
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