Abstract
Purpose
Incidentally discovered pulmonary embolism is a prevalent clinical problem for cancer patients and contributes significantly to the burden of cancer-associated thrombosis. The aim of this study was to explore if outpatient management of incidental pulmonary embolism (iPE) in cancer patients is effective and can be conducted safely.
Methods/patients
We performed a prospective observational cohort study in a single Spanish tertiary hospital. Patients diagnosed with iPE and active cancer were enrolled. Between May 2016 and May 2017, 25 consecutive patients were included in the study.
Results
All patients were assessed in the emergency room (ER) and started treatment with low-molecular weight heparins (LMWH) being discharged in the following 24 h. Congestive heart failure and right ventricular dysfunction were ruled out, and none of them presented massive PE, active bleeding or any disease-related reason that required hospitalization. The 90-day follow-up visit showed no venous thromboembolism (VTE) recurrence and the major bleeding rate was 4%. Mortality rate at 30 and 90 days was 0%.
Conclusions
Outpatient management for iPE in cancer patients appears to be feasible and safe in selected cancer patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(3033–69):3069a–.
Stein PD, Matta F, Hughes MJ. National trends in home treatment of acute pulmonary embolism. Clin Appl Thromb Hemost. 2018;24:115–21.
Stein PD, Matta F, Hughes PG, Hourmouzis ZN, Hourmouzis NP, White RM, et al. Home treatment of pulmonary embolism in the era of novel oral anticoagulants. Am J Med. 2016;129:974–7.
Kraaijpoel N, Bleker SM, Meyer G, Mahé I, Muñoz A, et al. Treatment and long-term clinical outcomes of incidental pulmonary embolism in patients with cancer: an international prospective cohort study. J Clin Oncol. 2019:JCO1801977.
den Exter PL, Hooijer J, Dekkers OM, Huisman MV. Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients. J Clin Oncol. 2011;29:2405–9.
Palla A, Rossi G, Falaschi F, Marconi L, Pistolesi M, Prandoni P. Is incidentally detected pulmonary embolism in cancer patients less severe? A case-control study. Cancer Invest. 2012;30:131–4.
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:2189–204.
Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2016;17:e452–e466466.
Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692-4.
Carmona-Bayonas A, Jiménez-Fonseca P, Font C, Fenoy F, Otero R, Beato C, et al. Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index. Br J Cancer. 2017;116:994–1001.
Ahn S, Cooksley T, Banala S, Buffardi L, Rice TW. Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism. Support Care Cancer. 2018;26:3601–7.
Funding
This study had no funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Andrés J. Muñoz Martin: Dr. Muñoz has received speakers’ honoraria or honoraria for participation in Advisory Boards from Sanofi, Celgene, Leo Pharma, Daiichi Sankyo, Pzifer-BMS, Rovi, Celgene, Shire, Astra-Zeneca and Medscape and research grants from Sanofi and Leo Pharma. Magdalena Carmen Ruiz Zamorano, María Carmen Viñuela Benéitez, Laura Ortega Morán and Ángela García Pérez declare that they have no conflict of interest. Dr. Miguel Martín Jiménez: Dr. Martin has received speakers’ honoraria or honoraria for participation in Advisory Boards from AstraZeneca, Novartis, Roche-Genentech, Pfizer Glaxo, Pharmamar, Taiho Oncology and Lilly, and research grants from Novartis and Roche.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Ethical approval
The study was approved by the Ethics Committee of Hospital General Universitario Gregorio Marañón, Madrid, Spain. The study has been approved by the appropriate institutional and/or national research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Muñoz Martín, A.J., Ruiz Zamorano, M.C., Viñuela Benéitez, M.C. et al. Outpatient management of incidental pulmonary embolism in cancer patient. Clin Transl Oncol 22, 612–615 (2020). https://doi.org/10.1007/s12094-019-02153-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-019-02153-4