Cancer associated thrombosis: comparison of characteristics, treatment, and outcomes in oncological and non-oncological patients followed by Pulmonary Embolism Response Team

Abstract

This study is a retrospective analysis of consecutive patients with venous thromboembolism (VTE) treated by the Pulmonary Embolism Response Team CELZAT (PERT-CELZAT) that compares the clinical characteristics, outcomes, and mortality of patients with and without cancer. It shows that patients with cancer can be successfully treated for pulmonary embolism (PE) with their in-hospital outcomes and mortality rate at the same level as patients without cancer. The study postulates that patients with PE, especially those in the intermediate and high-risk group or with contraindications for standard therapy, should be followed by a multidisciplinary team. This may result in lower complication rates and lower in-hospital mortality. However, the long-term follow-up shows that, despite successful treatment in the acute phase, the cancer patients had shorter survival times, which may be associated with the progression of neoplastic disease.

Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism

“…Advanced oncological disease is reported to be the most common cause of death in the posthospital period [30][31][32]. A recent study indicated three times higher mortality during 12 months after PE diagnosis as compared to non-oncological patients [33]. There was one case of ischemic stroke after the CDMT procedure in our cohort.…”

Treatment of high- and intermediate-high-risk pulmonary embolism by the Pulmonary Embolism Response Team: Focus on catheter-directed therapies

“…This might be associated with a lack of standardized algorithms to select patients for advanced PE therapies and variable operator experience due to the imperfect effectiveness of CDTx, especially in patients with HR PE or comorbidities like malignancy. For example, our recent analysis of cancer-associated thrombosis demonstrated that oncological patients have similar in-hospital survival rates to non-oncological patients but worse long-term outcomes because of their underlying neoplastic disease [ 25 ]. Hence, our analysis is crucial to understand the factors associated with treatment outcomes and optimize future treatment decisions of PERT.…”

“…This might be associated with a lack of standardized algorithms to select patients for advanced PE therapies and variable operator experience due to the imperfect effectiveness of CDTx, especially in patients with HR PE or comorbidities like malignancy. For example, our recent analysis of cancer-associated thrombosis demonstrated that oncological patients have similar in-hospital CDT -catheter-directed thrombectomy; CDL -catheter-directed thrombolysis; CPR -cardiopulmonary resuscitation; F -female; ICD -implantable cardioverter-defibrillator; IVCf -inferior vena cava filter; M -male; N/A -not applicable; NYHA FC -New York Heart Association Functional Classification; PE -pulmonary embolism; PESI -Pulmonary Embolism Severity Index; sPESI -simplified PESI; SE -surgical embolectomy; ST -systemic thrombolysis; rtPA -recombinant tissue plasminogen activator survival rates to non-oncological patients but worse long-term outcomes because of their underlying neoplastic disease [25]. Hence, our analysis is crucial to understand the factors associated with treatment outcomes and optimize future treatment decisions of PERT.…”

A practical approach to the 2022 ESC cardio-oncology guidelines: Comments by a team of experts – cardiologists and oncologists

“…From a practical point of view, prompt diagnosis of pulmonary embolism appears to be the most important issue, as it is an acute disease requiring immediate initiation of anticoagulant therapy. Oncology patients may require consultation from the acute pulmonary embolism response team (PERT) due to the numerous contraindications to thrombolytic therapy [41]. For dasatinib-induced NP, the drug should be discontinued, and another TKI should be used.…”