A Clinical Prognostic Model for the Identification of Low-Risk Patients With Acute Symptomatic Pulmonary Embolism and Active Cancer

Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

“…4) Beyond symptoms, the presence of abnormal vital signs (such as systolic blood pressure <100 mmHg, heart rate >100 beats per minute and oxygen saturation <95%) predicted an increased risk of short-term mortality. Previous studies have arrived at the same conclusion [7,8], suggesting that these clinical signs are the "red flags" to watch out for when managing a patient with cancer-associated PE.…”

“…Third, the advantage of a three-group classification is unclear to us when the authors actually clearly showed that only the TA-UPE group had its distinct (low) mortality profile. This criticism, however, should not conceal that the current study is, among other previous work on this issue [7,8,22], a stringent attempt to classify cancer-associated PE. Regarding antithrombotic therapy, two end-points are of interest, namely recurrent VTE and major bleeding [9].…”

“…Finally, guideline-endorsed risk assessment models that inform whether patients with PE should be hospitalised or may be treated as outpatients, such as the (simplified) Pulmonary Embolism Severity Index ((s)PESI) [13,14], have limited utility for cancer patients, because they innately classify cancer patients in the "not low-risk" categories [15] or even fail to predict short-term mortality at all [16]. Therefore, cancer-specific PE risk tools have been developed [7,8], but they do not account for UPE. Thus, contemporary clinical data that could fill this evidence gap are much needed to identify patients with cancer-associated PE who can safely be treated as outpatients [17,18].…”

VTE Registry: What Can Be Learned from RIETE?

“…We also produced prognostic scores to identify outpatients with DVT at low risk for complications,29 cancer patients at increased risk of dying,30 predictors for fatal PE,31 or to identify cancer patients with PE at low risk for complications 32…”

Cost of Treating Venous Thromboembolism With Heparin and Warfarin Versus Home Treatment With Rivaroxaban

“…While DVT has been treated as an outpatient for many years, recently developed risk stratification tools have been validated to select patients with PE who have a low risk of shortterm complications. [1][2][3][4][5][6][7] In particular, the Hestia criteria identifies a subgroup of PE patients who have a 1.0% mortality rate as outpatients over 3 months and a low rate of short-term complications requiring rehospitalization. 8 In this article, we assumed that many patients with DVT have undiagnosed PE and therefore must undergo the same risk stratification as patients with documented PE.…”