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Risk of Recurrent Venous Thromboembolism and Major Haemorrhage in Cancer-Associated Incidental Pulmonary Embolism amongst Treated and Untreated Patients: a pooled analysis of 926 patients.
J Thromb Haemost. 2015 Oct 15;
Authors: van der Hulle T, den Exter PL, Planquette B, Meyer G, Soler S, Monreal M, Jiménez D, Portillo AK, O'Connell C, Liebman HA, Shteinberg M, Adir Y, Tiseo M, Bersanelli M, Abdel-Razeq HN, Mansour AH, Donnelly OG, Radhakrishna G, Ramasamy S, Bozas G, Maraveyas A, Shinagare AB, Hatabu H, Nishino M, Huisman MV, Klok FA
Abstract
INTRODUCTIONS: Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on CT-scan not performed for suspected PE. IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. We aimed to provide the best available evidence on IPE management.
METHODS: Incidence rates of symptomatic recurrent venous thromboembolism (VTE), major haemorrhage and mortality during 6-month follow-up were pooled using individual patient data from studies identified by a systematic literature search. Subgroup analyses based on cancer stage, thrombus localization and management were performed.
RESULTS: In 926 cancer patients with IPE from 11 cohorts, weighted pooled 6-month risks of recurrent VTE, major haemorrhage and mortality were 5.8% (95%CI 3.7-8.3), 4.7% (95%CI 3.0-6.8) and 37% (95%CI 28-47). VTE recurrence risk was comparable under low molecular weight heparins (LMWH) and vitamin-K antagonists (VKA) (6.2% vs. 6.4%; hazard ratio (HR) 0.9; 95%CI 0.3-3.1), while 12% in untreated patients (HR 2.6; 95%CI 0.91-7.3). Risk of major haemorrhage was higher under VKA than LMWH (13% vs 3.9%; HR 3.9; 95%CI 1.6-10). VTE recurrence risk was comparable in patients with an subsegmental IPE and those with a more proximally localized IPE (HR 1.1; 95%CI 0.50-2.4).
CONCLUSION: These results support the current recommendation to anticoagulate cancer-associated IPE with LMWH and argue against different management of subsegmental IPE. This article is protected by copyright. All rights reserved.
PMID: 26469193 [PubMed - as supplied by publisher]