T van der Hulle1, P L den Exter1, B Planquette2, G Meyer2, S Soler3, M Monreal4, D Jiménez5, A K Portillo5, C O'Connell6, H A Liebman6, M Shteinberg7,8, Y Adir7, M Tiseo9, M Bersanelli9, H N Abdel-Razeq10, A H Mansour10, O G Donnelly11, G Radhakrishna12, S Ramasamy12, G Bozas13, A Maraveyas14, A B Shinagare15, H Hatabu15, M Nishino15, M V Huisman1, F A Klok1. 1. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Respiratory and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris Descartes, INSERM U 965, Paris, France. 3. Department of Internal Medicine, Hospital Sant Jaume, Olot, Gerona, Spain. 4. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. 5. Respiratory Department, Ramon y Cajal Hospital, IRYCIS and Alcala de Henares University, Madrid, Spain. 6. Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 7. Pulmonology Institute, Faculty of Medicine, Carmel Medical Center, Technion, Israel Institute of Technology, Haifa, Israel. 8. CF Center, Faculty of Medicine, Carmel Medical Center, Technion, Israel Institute of Technology, Haifa, Israel. 9. Medical Oncology Unit, University Hospital of Parma, Parma, Italy. 10. Department of Internal Medicine and Department of Radiology, King Hussein Cancer Center, Amman, Jordan. 11. Leeds Institute of Cancer and Pathology, University of Leeds and St James' Institute of Oncology, Leeds, UK. 12. St James' Institute of Oncology, Leeds, UK. 13. Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK. 14. Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, Cottingham, UK. 15. Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.
Abstract
UNLABELLED: ESSENTIALS: We performed a pooled analysis of 926 patients with cancer-associated incidental pulmonary embolism (IPE). Vitamin K antagonists (VKA) are associated with a higher risk of major hemorrhage. Recurrence risk is comparable after subsegmental and more proximally localized IPE. Our results support low molecular weight heparins over VKA and similar management of subsegmental IPE. BACKGROUND: Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on computed tomography scanning 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 hemorrhage, 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 hemorrhage and mortality were 5.8% (95% confidence interval [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 (VKAs) (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 hemorrhage was higher under VKAs than under 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.
UNLABELLED: ESSENTIALS: We performed a pooled analysis of 926 patients with cancer-associated incidental pulmonary embolism (IPE). Vitamin K antagonists (VKA) are associated with a higher risk of major hemorrhage. Recurrence risk is comparable after subsegmental and more proximally localized IPE. Our results support low molecular weight heparins over VKA and similar management of subsegmental IPE. BACKGROUND: Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on computed tomography scanning not performed for suspected PE. IPE has been estimated to occur in 3.1% of all cancerpatients 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 hemorrhage, 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 cancerpatients with IPE from 11 cohorts, weighted pooled 6-month risks of recurrent VTE, major hemorrhage and mortality were 5.8% (95% confidence interval [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 (VKAs) (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 hemorrhage was higher under VKAs than under 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.
Authors: A J Muñoz Martín; E Gallardo Díaz; I García Escobar; R Macías Montero; V Martínez-Marín; V Pachón Olmos; P Pérez Segura; T Quintanar Verdúguez; M Salgado Fernández Journal: Clin Transl Oncol Date: 2020-01-24 Impact factor: 3.405
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Authors: P Jimenez-Fonseca; A Carmona-Bayonas; C Calderon; J Fontcuberta Boj; C Font; R Lecumberri; M Monreal; A J Muñoz Martín; R Otero; A Rubio; P Ruiz-Artacho; C Suarez Fernández; E Colome; P Pérez Segura Journal: Clin Transl Oncol Date: 2017-02-27 Impact factor: 3.405
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