학술논문
Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients
Document Type
Academic Journal
Author
van der Hulle, T.; den Exter, P. L.; Planquette, B.; Meyer, G.; Soler, S.; Monreal, M.; Jiménez, D.; Portillo, A. K.; OʼConnell, C.; Liebman, H. A.; Shteinberg, M.; Adir, Y.; Tiseo, M.; Bersanelli, M.; Abdel-Razeq, H. N.; Mansour, A. H.; Donnelly, O. G.; Radhakrishna, G.; Ramasamy, S.; Bozas, G.; Maraveyas, A.; Shinagare, A. B.; Hatabu, H.; Nishino, M.; Huisman, M. V.; Klok, F. A.
Source
Journal of Thrombosis and Haemostasis. Jan 01, 2016 14(1):105-113
Subject
Language
English
ISSN
1538-7933
Abstract
BACKGROUND.: Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on computed tomography scanning not performed for suspected PE. IPE has been estimated to occur in 3.1% of all cancer patients and is a growing challenge for clinicians and patients. Nevertheless, knowledge about the treatment and prognosis of cancer-associated IPE is scarce. We aimed to provide the best available evidence on IPE management. METHODS.: Incidence rates of symptomatic recurrent venous thromboembolism (VTE), major hemorrhage, and mortality during 6-month follow-up were pooled using individual patient data from studies identified by a systematic literature search. Subgroup analyses based on cancer stage, thrombus localization, and management were performed. RESULTS.: In 926 cancer patients with IPE from 11 cohorts, weighted pooled 6-month risks of recurrent VTE, major hemorrhage and mortality were 5.8% (95% confidence interval [CI] 3.7–8.3%), 4.7% (95% CI 3.0–6.8%), and 37% (95% CI 28–47%). VTE recurrence risk was comparable under low molecular weight heparins (LMWH) and vitamin K antagonists (VKAs) (6.2% vs. 6.4%; hazard ratio [HR] 0.9; 95% CI 0.3–3.1), while 12% in untreated patients (HR 2.6; 95% CI 0.91–7.3). Risk of major hemorrhage was higher under VKAs than under LMWH (13% vs. 3.9%; HR 3.9; 95% CI 1.6–10). VTE recurrence risk was comparable in patients with an subsegmental IPE and those with a more proximally localized IPE (HR 1.1; 95% CI 0.50–2.4). CONCLUSION.: These results support the current recommendation to anticoagulate cancer-associated IPE with LMWH and argue against different management of subsegmental IPE. ESSENTIALS.