TY - JOUR
T1 - Clinical characteristics and 3-month outcomes in cancer patients with incidental versus clinically suspected and confirmed pulmonary embolism
AU - Peris, Marisa
AU - López-Nunez, Juan J.
AU - Maestre, Ana
AU - Jimenez, David
AU - Muriel, Alfonso
AU - Bikdeli, Behnood
AU - Weinberg, Ido
AU - Ay, Cihan
AU - Mazzolai, Lucia
AU - Lorenzo, Alicia
AU - Monreal, Manuel
AU - RIETE Investigators
A2 - Monreel, Manuel
A2 - Prandoni, Paolo
A2 - Brenner, Benjamin
A2 - Farge-Bancel, Dominique
A2 - Barba, Raquel
A2 - Di Micco, Pierpaolo
A2 - Bertoletti, Laurent
A2 - Schellong, Sebastian
A2 - Tzoran, Inna
A2 - Reis, Abilio
A2 - Bosevski, Marijan
A2 - Bounameaux, Henri
A2 - Malý, Radovan
A2 - Verhamme, Peter
A2 - Caprini, Joseph A.
A2 - Bui, Hanh My
A2 - Adarraga, M. D.
A2 - Agud, M.
A2 - Aibar, J.
A2 - Aibar, M. A.
A2 - Alfonso, J.
A2 - Amado, C.
A2 - Aramberri, M.
A2 - Arcelus, J. I.
A2 - Ballaz, A.
A2 - Barba, R.
A2 - Barbagelata, C.
A2 - Barrón, M.
A2 - Barrón-Andrés, B.
A2 - Blanco-Molina, A.
A2 - Camon, A. M.
A2 - Canas, I.
A2 - Cerdà, P.
A2 - Criado, J.
A2 - de Ancos, C.
A2 - de Miguel, J.
A2 - del Toro, J.
A2 - Kigitovica, D.
A2 - Skride, A.
A2 - Make, K.
N1 - Funding Information:
Support statement: This work was supported by Sanofi España. Funding information for this article has been deposited with the Crossref Funder Registry.
Publisher Copyright:
© ERS 2021
PY - 2021/7/1
Y1 - 2021/7/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85109717214&partnerID=8YFLogxK
U2 - 10.1183/13993003.02723-2020
DO - 10.1183/13993003.02723-2020
M3 - Article
C2 - 33303548
AN - SCOPUS:85109717214
SN - 0903-1936
VL - 58
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
M1 - 2002723
ER -
