TY - JOUR
T1 - Treatment and long-term clinical outcomes of incidental pulmonary embolism in patients with cancer: An international prospective cohort study
AU - Kraaijpoel, Noémie
AU - Bleker, Suzanne M.
AU - Meyer, Guy
AU - Mahé, Isabelle
AU - Muñoz, Andrés
AU - Bertoletti, Laurent
AU - Bartels-Rutten, Annemarieke
AU - Beyer-Westendorf, Jan
AU - Porreca, Ettore
AU - Boulon, Carine
AU - van Es, Nick
AU - Iosub, Diana I.
AU - Couturaud, Francis
AU - Biosca, Mercedes
AU - Lerede, Teresa
AU - Lacroix, Philippe
AU - Maraveyas, Anthony
AU - Aggarwal, Anita
AU - Girard, Philippe
AU - Büller, Harry R.
AU - di Nisio, Marcello
AU - UPE investigators
AU - Accassat, S.
AU - Aquilant, S.
AU - Assaf, J. D.
AU - Baars, J.
AU - Beenen, L. M.
AU - Bergmann, J. F.
AU - Bozas, G.
AU - Caliandro, R.
AU - Carrier, M.
AU - Confrere, E.
AU - Constans, J.
AU - Désormais, I.
AU - Dublanchet, N.
AU - Endig, S.
AU - Falanga, A.
AU - Falvo, N.
AU - Ferrer Pérez, Al
AU - García Escobar, I.
AU - Gonzàlez Santiago, S.
AU - Grange, C.
AU - Helfer, H.
AU - Kleinjan, A.
AU - Lalezari, F.
AU - de Magalhaes, E.
AU - Marten, S.
AU - Martinez del Prado, P.
AU - Otten, H. M.
AU - Paleiron, N.
AU - Pérez Ramírez, S.
PY - 2019
Y1 - 2019
N2 - PURPOSE Pulmonary embolism is incidentally diagnosed in up to 5% of patients with cancer on routine imaging scans. The clinical relevance and optimal therapy for incidental pulmonary embolism, particularly distal clots, is unclear. The aim of the current study was to assess current treatment strategies and the long-term clinical outcomes of incidentally detected pulmonary embolism in patients with cancer. PATIENTS AND METHODS We conducted an international, prospective, observational cohort study between October 22, 2012, and December 31, 2017. Unselected adults with active cancer and a recent diagnosis of incidental pulmonary embolism were eligible. Outcomes were recurrent venous thromboembolism, major bleeding, and all-cause mortality during 12 months of follow-up. Outcome events were centrally adjudicated. RESULTS A total of 695 patients were included. Mean age was 66 years and 58% of patients were male. Most frequent cancer types were colorectal (21%) and lung cancer (15%). Anticoagulant therapy was initiated in 675 patients (97%), of whom 600 (89%) were treated with low-molecular-weight heparin. Recurrent venous thromboembolism occurred in 41 patients (12-month cumulative incidence, 6.0%; 95% CI, 4.4% to 8.1%), major bleeding in 39 patients (12-month cumulative incidence, 5.7%; 95% CI, 4.1% to 7.7%), and 283 patients died (12-month cumulative incidence, 43%; 95% CI, 39% to 46%). The 12-month incidence of recurrent venous thromboembolism was 6.4% in those with subsegmental pulmonary embolism compared with 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio, 1.1; 95% CI, 0.37 to 2.9; P = .93). CONCLUSION In patients with cancer with incidental pulmonary embolism, risk of recurrent venous thromboembolism is significant despite anticoagulant treatment. Patients with subsegmental pulmonary embolism seemed to have a risk of recurrent venous thromboembolism comparable to that of patients with more proximal clots.
AB - PURPOSE Pulmonary embolism is incidentally diagnosed in up to 5% of patients with cancer on routine imaging scans. The clinical relevance and optimal therapy for incidental pulmonary embolism, particularly distal clots, is unclear. The aim of the current study was to assess current treatment strategies and the long-term clinical outcomes of incidentally detected pulmonary embolism in patients with cancer. PATIENTS AND METHODS We conducted an international, prospective, observational cohort study between October 22, 2012, and December 31, 2017. Unselected adults with active cancer and a recent diagnosis of incidental pulmonary embolism were eligible. Outcomes were recurrent venous thromboembolism, major bleeding, and all-cause mortality during 12 months of follow-up. Outcome events were centrally adjudicated. RESULTS A total of 695 patients were included. Mean age was 66 years and 58% of patients were male. Most frequent cancer types were colorectal (21%) and lung cancer (15%). Anticoagulant therapy was initiated in 675 patients (97%), of whom 600 (89%) were treated with low-molecular-weight heparin. Recurrent venous thromboembolism occurred in 41 patients (12-month cumulative incidence, 6.0%; 95% CI, 4.4% to 8.1%), major bleeding in 39 patients (12-month cumulative incidence, 5.7%; 95% CI, 4.1% to 7.7%), and 283 patients died (12-month cumulative incidence, 43%; 95% CI, 39% to 46%). The 12-month incidence of recurrent venous thromboembolism was 6.4% in those with subsegmental pulmonary embolism compared with 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio, 1.1; 95% CI, 0.37 to 2.9; P = .93). CONCLUSION In patients with cancer with incidental pulmonary embolism, risk of recurrent venous thromboembolism is significant despite anticoagulant treatment. Patients with subsegmental pulmonary embolism seemed to have a risk of recurrent venous thromboembolism comparable to that of patients with more proximal clots.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068051210&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31116676
U2 - https://doi.org/10.1200/JCO.18.01977
DO - https://doi.org/10.1200/JCO.18.01977
M3 - Article
C2 - 31116676
SN - 0732-183X
VL - 37
SP - 1713
EP - 1720
JO - Journal of clinical oncology
JF - Journal of clinical oncology
IS - 20
ER -