Pulmonary Embolism in the Cancer Associated Thrombosis Landscape

Abstract

In cancer patients, pulmonary embolism (PE) is the second leading cause of death after the cancer itself, most likely because of difficulties in diagnosing the disease due to its nonclassical presentation. The risk of PE recurrence and possibly the case-fatality rate depends on whether the patient presents a symptomatic PE, an unsuspected PE, a subsegmental PE, or a catheter-related PE. Choosing the best therapeutic option is challenging and should consider the risk of both the recurrence of thrombosis and the occurrence of bleeding. The purpose of this review is to provide an overview of the clinical characteristics and the treatment of cancer-associated PE, which could benefit clinicians to better manage the deadliest form of thrombosis associated with cancer. After a brief presentation of the epidemiological data, we will present the current attitude towards the diagnosis and the management of cancer patients with PE. Finally, we will discuss the perspectives of how the medical community can improve the management of this severe medical condition.

Characteristics and 6-Month Mortality of Medical Oncology Patients With Incidental and Symptomatic Pulmonary Embolism: A Single-Institutional Retrospective Longitudinal Analysis

“…It is well-established that cancer is one of the major acquired risk factors for venous thromboembolism (VTE) with a fourfold to sevenfold increased risk to develop the disease. 1 Data from multiple studies suggest up to 20% of cancer patients develop VTE, including pulmonary embolism (PE) which is the second leading cause of death after the cancer itself in this group. 1 , 2 In turn, cancer has been found to be an independent predictor of death in series of patients with acute PE 3 and has been included as a predictive variable in validated PE prognostic models.…”

A Review of FXIa Inhibition as a Novel Target for Anticoagulation

“…13 Although ASOs like IONIS FXI-LRx (ISIS 416858) provide “proof-of-concept” of improved adherence of long-term anticoagulation with a long half-life by inhibiting biosynthesis of FXIa, the clinical community has favored small molecule FXIa inhibitors like asundexian (BAY2433334) that have a “fast onset–fast offset” profile that can in theory be useful in patients on chronic anticoagulant therapy needing temporary interruption due to bleeding, need of critical care, or periprocedural situations. 14 The idea of long-term FXI inhibition could potentially be applied for similar indications as DOACs currently have for prevention of arterial or VTE, especially when perceived bleed risk causes providers to opt for inappropriate low-dose DOAC regimens. Oral FXI inhibitors could also be approved for novel long-term indications such as in the case of non-cardioembolic ischemic stroke prevention, where no anticoagulants are currently approved.…”

Uso de los nuevos anticoagulantes orales en el síndrome antifosfolipidico: revisión bibliográfica

“…No obstante, el uso de los mismos aún está restringido en población con mayor riesgo de sangrado asociado a anticoagulantes (pacientes con cáncer y pacientes frágiles), en ciertos pacientes no está recomendado o no es factible su uso (pacientes con insuficiencia renal terminal, embarazo y lactancia) o su aplicación es ineficaz (pacientes con síndrome antifosfolípido triple positivo), por lo que aún existe la necesidad de fármacos anticoagulantes nuevos y mejorados (19).…”