Treatment and long-term clinical outcomes of incidental pulmonary embolism in cancer patients: an international prospective cohort study

Kraaijpoel, Noémie; Bleker, Suzanne M.; Es, Nick van; Mahé, Isabelle; Muñoz, Andrés; Meyer, Guy; Planquette, Benjamin; Sanchez, Olivier; Bertoletti, Laurent; Accassat, Sandrine; Magalhaes, Élodie De; Baars, Joke W.; Rutten, Annemarieke; Lalezari, Ferry; Beyer‐Westendorf, Jan; Endig, S.; Marten, Sandra; Porreca, Ettore; Rutjes, Anne W S; Russi, Ilaria; Constans, J.; Boulon, Carine; Kleinjan, A.; Beenen, Ludo F. M.; Iosub, Diana Irina; Piovella, Franco; Couturaud, F.; Tromeur, Cécile; Biosca, M.; Assaf, J.D.; Helfer, H. L.; Pinson, Michèle; Lerede, Teresa; Falanga, Anna; Lacroix, Philippe; Desormais, Iléana; Maraveyas, Anthony; Bozas, George; Aggarwal, Anita; Rickles, Frederick R.; Girard, Philippe; Caliandro, R.; Prado, Purificación Martínez del; Maneiro, C. de Prado; Escobar, Ignacio; Santiago, S; Schmidt, Jeannot; Dublanchet, N.; Aquilanti, Sandro; Confrere, E.; Paleiron, Nicolas; Grangé, C.; Sevestre, Marie‐Antoinette; Perez, A.; Fernández, Mercedes Salgado; Falvo, Nicolas; Thaler, Johannes; Otten, Hans Martin; Carrier, Marc; Jf, Bergmann; Büller, Harry R.; Nisio, Marcello Di

doi:10.1016/j.thromres.2018.02.034

Cited by 6 publications

(11 citation statements)

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“…Although the relative effect of DOAC on symptomatic VTE event reduction, unlike that for the overall VTE, was not statistically significant, the inclusion of asymptomatic events in the recent DOAC trials were consistent with guideline recommendations . This is especially relevant for cancer patients with incidental PE, in which a large international prospective study recently demonstrated a high rate of VTE recurrence and mortality despite anticoagulation . Although the efficacy and safety of DOAC and LMWH appear to be similar, formal econometric analyses and network meta‐analyses comparing prophylactic DOAC, LMWH, and placebo are needed including the cost of VTE‐related and bleeding‐related hospitalizations, complications, and follow‐up care to fully inform future policy decisions and guideline recommendations.…”

Section: Discussionmentioning

confidence: 79%

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Kuderer

García

et al. 2019

Journal of Thrombosis and Haemostasis

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Background It is unclear if direct oral anticoagulant (DOAC) is efficacious and safe for prophylaxis of venous thromboembolism (VTE) in ambulatory patients with cancer. Methods We performed a systematic review using EMBASE, MEDLINE, and CENTRAL. Inclusion criteria included adult ambulatory patients with cancer, prophylactic use of DOAC, and randomized controlled trials. Exclusion criteria included pediatric patients, inpatient or postoperative setting, therapeutic indication of DOAC, or non‐phase III randomized controlled trial. Two authors screened/reviewed articles and abstracted the data. Meta‐analysis was performed using random‐effects model. Efficacy outcome included overall and symptomatic VTE incidence during the first 6 months. Safety outcomes included major bleeding and clinically relevant non‐major bleeding (CRNMB) incidence during the on‐treatment period. Subgroup analysis was performed for intermediate‐ and high‐risk Khorana score. Results A total of 202 records were identified and 28 full‐text articles were assessed. Two studies with 1415 participants were included for meta‐analysis. For DOAC vs placebo, the relative risks for overall and symptomatic VTE incidence by 6 months were 0.56 (0.35‐0.89) and 0.58 (0.29‐1.13), respectively. The relative risks for major bleeding and CRNMB while on‐treatment were 1.96 (0.80‐4.82) and 1.28 (0.74‐2.20), respectively. Patients with high‐risk Khorana score (3+) derived the largest absolute risk reduction of VTE. Conclusions Low‐dose DOAC reduces the rate of overall VTE in higher risk cancer patients starting systemic chemotherapy. It may reduce the rate of symptomatic VTE but increase the likelihood of bleeding.

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Section: Discussionmentioning

confidence: 79%

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Kuderer

García

et al. 2019

Journal of Thrombosis and Haemostasis

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“…We also confirmed the results of previous studies of cancer patients with incidental events, who are characterized by a similar prognosis as those with symptomatic PE. [7][8][9][24][25][26] Further, incidental PE is associated with a worse prognosis than no VTE, as the median survival was 8 months in patients with incidental PE and 12 months for the controls of patients with matched cancer but without PE. 8 In this context, our data suggest that cancer- associated incidental VTE should be treated similarly to symptomatic VTE.…”

Section: Discussionmentioning

confidence: 99%

“…5 Among cancer patients, the prevalence of incidental VTE on routine computed tomography imaging is approximately 5%, 6 and there is growing evidence that the recurrence risk in this subgroup of population is significant despite anticoagulation therapy. 7 Patients with cancer-associated incidental VTE may have similar risks of recurrence, bleeding, and mortality as those with symptomatic VTE. [7][8][9] Therefore, the American Society of Clinical Oncology recommends virtually the same therapy for incidental and symptomatic VTE in cancer patients, 10 and recent major phase III trials on novel anticoagulant agents for cancer-associated VTE accepted the enrolment of patients from either group.…”

Section: Introductionmentioning

confidence: 99%

“…7 Patients with cancer-associated incidental VTE may have similar risks of recurrence, bleeding, and mortality as those with symptomatic VTE. [7][8][9] Therefore, the American Society of Clinical Oncology recommends virtually the same therapy for incidental and symptomatic VTE in cancer patients, 10 and recent major phase III trials on novel anticoagulant agents for cancer-associated VTE accepted the enrolment of patients from either group. 11 The course of incidental VTE and the risk-benefit balance of therapeutic anticoagulation remain to be investigated in the noncancer setting, such as among patients with chronic obstructive pulmonary disease, stroke, coronary artery disease, pulmonary infection, or major trauma or surgery.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

et al. 2020

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Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

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“…Despite increasing data regarding the optimal management of VTE in stable cancer patients, important clinical challenges remain, particularly in patients presenting with concern for acute clinical compromise or potential mortality. Recent studies have highlighted the impact of anti‐coagulant therapy on long‐term clinical outcomes associated with incidental pulmonary embolism in cancer 4 . However, the impacts of more short‐term procedural interventions, including catheter directed thrombolytic therapy (CDL) in the presence of cancer, remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

The effect of catheter‐directed thrombolytic use on readmission rates and in‐hospital outcomes among cancer patients with venous thromboembolism in the United States

et al. 2020

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Background Cancer inducing a hypercoagulable state, venous thromboembolism (VTE) remains a leading cause of morbidity and mortality globally. We assessed the impacts of cancer on the likelihood for readmission after a VTE‐targeted procedure. Methods We created a new cohort using discharge‐level data from all hospitalizations from State Inpatient Databases of geographically dispersed participating states (18‐27 states). Results In those presenting with VTE during index‐admission (619 241), 2.4% patients underwent catheter directed thrombolytic therapy (CDL) on index admission and among those 20.3% had cancer. Moreover, the 30‐day readmission rate amongst CDL recipients (10 776 overall) was 14.3% in those with cancer compared to 8.8% in those with no cancer history (P < .0001). Additionally, in‐hospital mortality (5.7% vs 1.1%; P = 0.009) and cost‐of‐care ($11 014 ± 914 vs $10 520 ± 534; P = .04) was significantly higher in cancer compared to noncancer. Conclusion The use of CDL does not appear to reduce the risk of returning for a VTE‐related admission in cancer.

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Treatment and long-term clinical outcomes of incidental pulmonary embolism in cancer patients: an international prospective cohort study

Cited by 6 publications

References 0 publications

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Direct oral anticoagulant for the prevention of thrombosis in ambulatory patients with cancer: A systematic review and meta‐analysis

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

The effect of catheter‐directed thrombolytic use on readmission rates and in‐hospital outcomes among cancer patients with venous thromboembolism in the United States

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