Pulmonary embolism prophylaxis in solid tumors: Exploring a paradigm shift.

Abstract

e18252 Background: Studies have found higher risk of development of pulmonary embolism (PE) in those with metastatic disease within the first year of diagnosis, predominantly in pancreatic cancer. Therapeutic anticoagulation is consequently recommended in pancreatic cancer. We thus hypothesized that the rate of PE would be highest in pancreatic cancer compared to other solid tumors. Methods: We queried the Nationwide Inpatient Sample between 1999-2014 using the ICD-9 codes for PE in association with the following solid tumor types: esophageal, colorectal, lung, stomach, breast, pancreatic, liver and small intestine. The primary diagnosis was the type of solid tumor and the secondary diagnosis was PE. Chi-square analysis was used to to analyze for the independence of two variables. Results: From 1999-2014 there was a total of 16,473 cases of PE in solid tumors. 1.9% of the pancreatic cancer admissions developed a PE, followed by 1.7%, 0.9% and 0.8% for lung, liver, and colorectal, respectively (p > 0.05). Overall mortality rate for PE in pancreatic, lung, and colorectal cancers decreased from 32% in 1999 to 15% in 2014. Conclusions: Earlier detection due to improved diagnostic modalities may have contributed to the decrease in overall mortality rate observed in lung, liver, and colorectal cancers diagnosed with PE from 1999-2014. The highest rate of admissions associated with PE was seen in pancreatic cancer: however the differences between the four cancers were not statistically significant. Future studies should focus on observational prospective data monitoring solid malignancies for PE. If the prevalence of PE is indeed similar in different types of cancers, we should consider the addition of therapeutic anticoagulation to the current recommendations.