Clinical characteristics and 3-month outcomes in cancer patients with incidental versus clinically suspected and confirmed pulmonary embolism
Por:
Peris M, Lopez-Nunez J, Maestre A, Jimenez D, Muriel A, Bikdeli B, Weinberg I, Ay C, Mazzolai L, Lorenzo A, Monreal M, RIETE Investigators
Publicada:
1 jul 2021
Resumen:
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 TromboEmbolica) 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.
Filiaciones:
Peris M:
CEU Univ, Univ CEU Cardenal Herrera, Dept Med, Castellon de La Plana, Spain
Consorcio Hosp Prov Castellon, Dept Internal Med, Castellon de La Plana, Spain
Lopez-Nunez J:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Maestre A:
Hosp Univ Vinalopo, Dept Internal Med, Alicante, Spain
Jimenez D:
Ramon & Cajal Hosp, Resp Dept, Madrid, Spain
Inst Ramon & Cajal Invest Sanitaria IRYCIS, Madrid, Spain
Muriel A:
Ramon & Cajal Hosp, Biostat Dept, Madrid, Spain
Inst Ramon & Cajal Invest Sanitaria IRYCIS, CIBERESP, Madrid, Spain
Bikdeli B:
Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Div, Boston, MA 02115 USA
Yale YNHH Ctr Outcomes Res & Evaluat CORE, New Haven, CT USA
Cardiovasc Res Fdn CRF, New York, NY USA
Weinberg I:
Harvard Med Sch, AMS Massachusetts Gen Hosp, Boston, MA 02115 USA
Ay C:
Med Univ Vienna, Clin Div Haematol & Haemostaseol, Dept Med 1, Vienna, Austria
Mazzolai L:
Ctr Hosp Univ Vaudois CHUV, Dept Angiol, Lausanne, Switzerland
Lorenzo A:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Monreal M:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
|