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Clinical Outcomes of Incidental Pulmonary Embolism in Patients With Cancer

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Key Points

  • The 12-month cumulative incidence of recurrent venous thromboembolism was 6.0%.
  • Bleeding and pulmonary embolism accounted for 3.8% of all deaths.

In an international prospective cohort study reported in the Journal of Clinical Oncology, Kraaijpoel et al found that incidental pulmonary embolism in patients with cancer is associated with substantial risk of recurrent venous thromboembolism, despite anticoagulant treatment.

Study Details

The study, conducted at 32 sites in nine countries in Europe and North America between October 2012 and December 2017, included 695 adults with active cancer and a recent diagnosis of incidental pulmonary embolism. Patients had a mean age of 66 years; 58% were male; and the most common cancer types were colorectal (21%) and lung cancer (15%).

Risk of Recurrent Venous Thromboembolism

Overall, anticoagulant therapy was given to 675 patients (97%), with 600 (89%) receiving low–molecular-weight heparin. Recurrent venous thromboembolism occurred in 41 patients, representing a 12-month cumulative incidence of 6.0%. Major bleeding occurred in 39 patients, representing a 12-month cumulative incidence of 5.7%. Overall, 283 patients died—a 12-month cumulative incidence of 43%. Cancer was the most common cause of death; bleeding and pulmonary embolism accounted for 3.8% of all deaths.

The 12-month incidence of recurrent venous thromboembolism was 6.4% in patient with subsegmental pulmonary embolism and 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio = 1.1, P = .93). Mortality was comparable in patients with subsegmental pulmonary embolism and those with more proximal pulmonary embolism.

The investigators concluded, “In patients with cancer with incidental pulmonary embolism, risk of recurrent venous thromboembolism is significant despite anticoagulant treatment. Patients with subsegmental pulmonary embolism seemed to have a risk of recurrent venous thromboembolism comparable to that of patients with more proximal clots.”

Noémie Kraaijpoel, MD, of the Department of Vascular Medicine, Amsterdam, UMC/University of Amsterdam, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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