International Journal of Clinical Oncology

, Volume 24, Issue 6, pp 727–730 | Cite as

Saddle pulmonary embolism and in-hospital mortality in patients with cancer

  • Ashley Prentice
  • Irene Ruiz
  • Erin R. WeedaEmail author
Original Article



Saddle pulmonary embolism (PE) has been associated with an increased risk of 1 year mortality when compared to non-saddle PE among patients with cancer. We sought to evaluate the association between saddle PE and in-hospital outcomes among patients with comorbid cancer.


The 2013 and 2014 United States National Inpatient Sample was used to identify adult patients hospitalized for acute PE. Only patients with an International Classification Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code indicating comorbid cancer were included. Identified admissions were stratified into the following 2 cohorts: saddle (defined as ICD-9-CM code = 415.13) and non-saddle PE. Multivariable logistic regression was performed to determine the association between saddle PE and the odds of in-hospital mortality after adjustment for age ≥ 80 years and sex.


A total of 10,660 admissions for acute PE in patients with comorbid cancer were identified. Of which, 4.5% (n = 475) had a saddle PE. Median age was 67 years (interquartile range = 58–76) and 48.9% were male. In-hospital mortality occurred in 6.1% of patients. Upon multivariable adjustment, the odds of in-hospital mortality were higher in saddle versus non-saddle PE (odds ratio = 1.51; 95% confidence interval 1.08–2.10).


In this retrospective study of admissions for acute PE in patients with comorbid cancer, saddle PE was associated with a higher odds of in-hospital mortality.


Pulmonary embolism Venous thrombosis Venous thromboembolism Neoplasms Hospital mortality 




Compliance with ethical standards

Conflict of interest

ERW has received research funding from Pfizer Inc. AP and IR have nothing to disclose.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors. This study was designated nonhuman research by the institutional review board at our institution.

Supplementary material

10147_2019_1406_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 KB)


  1. 1.
    Heit JA, Silverstein MD, Mohr DN et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism. Arch Intern Med 160:809–815CrossRefGoogle Scholar
  2. 2.
    Winter PC (2006) The pathogenesis of venous thromboembolism in cancer: emerging links with tumour biology. Hematol Oncol 24:126–133CrossRefGoogle Scholar
  3. 3.
    Prandoni P, Lensing AW, Piccioli A et al (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484–3488CrossRefGoogle Scholar
  4. 4.
    Pathak R, Giri S, Karmacharya et al (2015) Comparison between saddle versus non-saddle pulmonary embolism: insights from nationwide inpatient sample. Int J Cardiol 180:58–59CrossRefGoogle Scholar
  5. 5.
    Yusuf SW, Gladish G, Lenihan DJ et al (2010) Computerized tomographic finding of saddle pulmonary embolism is associated with high mortality in cancer patients. Intern Med J 40:293–299CrossRefGoogle Scholar
  6. 6.
    HCUP Databases: National (Nationwide) Inpatient Sample (NIS), 2013–2014. Agency for Healthcare Research and Quality, Rockville. Accessed 6 Jan 2018
  7. 7.
    Databases HCUP: HCUP overview. Healthcare Cost and Utilization Project (HCUP), 2013–2014. Agency for Healthcare Research and Quality, Rockville. Accessed 6 Jan 2018
  8. 8.
    Ryu JH, Pellikka PA, Froehling DA et al (2007) Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome. Respir Med 101:1537–1542CrossRefGoogle Scholar
  9. 9.
    Pruszczyk P, Pacho R, Ciurzynski M et al (2003) Short term clinical outcome of acute saddle pulmonary embolism. Heart 89:335–336CrossRefGoogle Scholar
  10. 10.
    Casazza F, Becattini C, Rulli E et al (2016) Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter? Intern Emerg Med 11:817–824CrossRefGoogle Scholar
  11. 11.
    Lau JK, Chow V, Brown A et al (2017) Predicting in-hospital death during acute presentation with pulmonary embolism to facilitate early discharge and outpatient management. PLoS One 12:e0179755CrossRefGoogle Scholar
  12. 12.
    Banala SR, Yeung SJ, Rice TW et al (2017) Discharge or admit? Emergency department management of incidental pulmonary embolism in patients with cancer: a retrospective study. Int J Emerg Med 10:19CrossRefGoogle Scholar
  13. 13.
    Dudzinski DM, Piazza G (2016) Multidisciplinary pulmonary embolism response teams. Circulation 133:98–103CrossRefGoogle Scholar
  14. 14.
    Nguyen E, Caranfa J, Lyman GH et al (2018) Clinical prediction rules for mortality in patients with pulmonary embolism and cancer to guide outpatient management: a meta-analysis. J Thromb Haemost 16:279–292CrossRefGoogle Scholar
  15. 15.
    Weeda ER, Caranfa JT, Zeichner SB et al (2017) External validation of generic and cancer-specific risk stratification tools in patients with pulmonary embolism and active cancer. J Natl Compr Cancer Netw 15:1476–1482CrossRefGoogle Scholar
  16. 16.
    Chan L, McGarey P, Sclafani JA (2018) Using large data sets for population-based health research. In: Gallin JI, Ognibene FP, Johnson LL (eds) Principles and practice of clinical research. Elsevier, LondonGoogle Scholar
  17. 17.
    Tamariz L, Harkins T, Nair V (2012) A systematic review of validated methods for identifying venous thromboembolism using administrative and claims data. Pharmacoepidemiol Drug Saf 21(Suppl 1):154–162CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.College of PharmacyMedical University of South CarolinaCharlestonUSA

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