Prevalência de tromboembolismo pulmonar incidental em pacientes oncológicos: análise retrospectiva em grande centro

Abstract

Background: Increased use of routine imaging exams has led to higher rates of incidental diagnosis of pulmonary thromboembolism (PTE), especially for management of disease in cancer patients, among whom it is an important factor in associated morbidity and mortality. Objective: To identify cases of incidental PTE in cancer patients examined with computed tomography (CT) of the thorax, correlating clinical features and associated risk factors. Methods: This is a retrospective study of all episodes of PTE diagnosed between January 2013 and June 2016, selecting cases involving cancer patients and dividing them into two subsets: those with clinical suspicion and those without clinical suspicion of pulmonary embolism (incidental cases). Results: At total of 468 patients had PTE during the period investigated and 23.1% of them were cancer patients, 44.4% of whom exhibited pulmonary embolism as an incidental finding of a chest CT. There was no statistical difference between the two subsets in terms of sex, age, or smoking. In terms of patients' admission status, 58.3% of the patients without clinical suspicion were outpatients and 41.7% of those with suspicion of PTE were admitted via the emergency room (p < 0.001). The most common cancer sites were lung (17.6%), intestine (15.7%), and breast (13.0%). Patients whose PTE were diagnosed incidentally exhibited a significantly greater rate of metastases, while there were no differences between the groups in terms of chemotherapy, radiotherapy, or recent surgery. Analysis of symptoms revealed that 41.9% of patients without clinical suspicion had complaints suggestive of PTE when they underwent the CT examination. Conclusions: Incidental PTE is common among cancer patients, especially those in outpatients follow-up and in advanced stages of the disease. Patients without clinical suspicion also had symptoms suggestive of PTE when they presented for chest CT.

Fatores de risco e métodos de profilaxia para o tromboembolismo venoso nos pacientes hospitalizados / Risk factors and prophylaxis of methods for venous thromboembolism in hospitalized patient

“…A Figura 1 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) mostra os resultados dos artigos científicos utilizados nesta pesquisa, provenientes da busca bibliográfica com os descritores específicos e gerais, realizada na Biblioteca Virtual em Saúde.…”

Performance Spect-Ct and Angio-Ct for Diagnosis of Pulmonary Thromboembolism in a Tertiary Oncology Centre

“…The comorbidities associated most strongly with TEP diagnosis were history of TEP, Deep vein thrombosis -TVP, the use of systemic anticoagulants, pulmonary diseases, and benign prostate hyperplasia BPH. 4,6,12 The most prevalent types of cancer in Group 1 were lung, breast, colorectal, and prostate. Lung, pancreas, and brain cancers were significantly associated with a positive TEP diagnosis (p=0.021, p=0.003, and p=0.043, respectively).…”

“…8,11 The cancro Lung, pancreas and brain were also described in a Brazilian retrospective study and an American cohort study, conducted from 2013 to 2017, which analysed the prevalence of incidental TEP in cancer patients showing a greater association of these types of cancer with thromboembolic event diagnosis and TEP. 12,15 Some studies have shown that patients with metastatic cancer had a greater association with the diagnosis of positive TEP. 1,6,12 However, we did not observe any significant association between metastatic cancer and TEP in our sample.…”

“…12,15 Some studies have shown that patients with metastatic cancer had a greater association with the diagnosis of positive TEP. 1,6,12 However, we did not observe any significant association between metastatic cancer and TEP in our sample. This may be due to the fact that we had such a small number of patients with metastatic disease; future studies could examine this relationship more thoroughly.…”

Challenges in the management of patients with pulmonary embolism in Brazil

“…(3) O risco de TEP aumenta com a idade, assim como ocorre com comorbidades frequentemente associadas ao envelhecimento, como as doenças cardiovasculares, pulmonares crônicas e oncológicas. (4,5) Esse perfil de pacientes mais complexos contribui para internações mais prolongadas, com custos mais elevados e maiores riscos de morbidade e mortalidade relacionados aos eventos tromboembólicos. (4) Diante da maior expectativa de vida da população nas últimas décadas, com elevação do índice de envelhecimento no Brasil de 268% de 1970 a 2010, principalmente nas regiões Sul e Sudeste, (6) observou-se um aumento do número de internações hospitalares por TEP: a média de internações em 2008 e 2019, respectivamente, foi de 2,57/100.000 habitantes e 4,44/100.000 habitantes.…”