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Risk of Recurrent Venous Thromboembolism and Major Haemorrhage in Cancer-Associated Incidental Pulmonary Embolism amongst Treated and Untreated Patients: a pooled analysis of 926 patients.

Abstract

INTRODUCTIONS:

Incidental pulmonary embolism (IPE) is defined as pulmonary embolism (PE) diagnosed on CT-scan 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 haemorrhage 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 haemorrhage and mortality were 5.8% (95%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 (VKA) (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 haemorrhage was higher under VKA than 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. This article is protected by copyright. All rights reserved.

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