scholarly journals High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism

2021 ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Performance Status ◽  
Tertiary Care ◽  
Eastern Cooperative Oncology Group ◽  
Care Hospital ◽  
Ecog Performance Status ◽  
Acute Pe ◽  
D Dimer ◽  
Active Cancer

Objectives: Acute pulmonary embolism (PE) is the main cause of death in cancer patients, but there are limited prognostic tools for the patients with active cancer and acute PE. We aimed to identify prognostic factors of 30-day mortality in patients with active cancer and acute PE. Methods: This retrospective observational study included all adult patients aged ≥18 years with active cancer and acute PE from February 2017 to February 2019 at the emergency department in tertiary care hospital, Seoul, Korea. The primary outcome is 30-day mortality. Results: A total of 178 patients were included with a mean age of 63.9 years (SD 10.4) and males of 52.8%. The overall 30-day mortality rate was 30.9%. In a multivariable logistic analysis, high D-dimer, defined as ≥median value of 14.7 µg/mL, with odds ratio (OR) 2.47 (95% confidence interval [CI], 1.15–5.33), high Pulmonary Embolism Severity Index (PESI) scores with OR 2.95 (95% CI, 1.21–7.75) for class IV and OR 2.90 (95% CI, 1.06–7.90) for class V, and Eastern Cooperative Oncology Group (ECOG) performance status 3/4 with OR 3.22 (95% CI, 1.18–8.76) were independent predictors of 30-day mortality. Conclusion: High D-dimer values, high PESI scores, and poor ECOG performance status may be reliable predictors of mortality in patients with active cancer and acute PE.

scholarly journals Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

2019 ◽  
Vol 28 (3) ◽  
pp. 264-272 ◽  
Author(s):  
Valdis Ģībietis ◽  
Dana Kigitoviča ◽  
Barbara Vītola ◽  
Sintija Strautmane ◽  
Andris Skride
Keyword(s):  
Pulmonary Embolism ◽  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Acute Pulmonary Embolism ◽  
All Cause Mortality ◽  
Acute Pe ◽  
D Dimer ◽  
Active Cancer ◽  
Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

scholarly journals Sex differences in presentation, management, and outcomes among patients hospitalized with acute pulmonary embolism

2020 ◽  
Vol 25 (6) ◽  
pp. 541-548
Author(s):  
Abby M Pribish ◽  
Sebastian E Beyer ◽  
Anna K Krawisz ◽  
Ido Weinberg ◽  
Brett J Carroll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Sex Differences ◽  
Acute Pulmonary Embolism ◽  
Tertiary Care ◽  
Smoking History ◽  
Care Hospital ◽  
Survival Difference ◽  
Advanced Therapies ◽  
The Impact ◽  
Acute Pe

While the presence of gender disparities in cardiovascular disease have been described, there is a paucity of data regarding the impact of sex in acute pulmonary embolism (PE). We identified all patients admitted to a tertiary care hospital with acute PE between August 1, 2012 through July 1, 2018. We stratified the presenting characteristics, management, and outcomes between women and men. Of the 2031 patients admitted with acute PE, 1081 (53.2%) were women. Women were more likely to present with dyspnea (59.8% vs 52.0%, p < 0.001) and less likely to present with hemoptysis (1.9% vs 4.0%, p = 0.01). Women were older (63.8 ± 17.4 years vs 62.3 ± 15.0 years, p = 0.04), but had lower rates of myocardial infarction, liver disease, smoking history, and prior DVT. PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; p = 0.19), yet women were more likely to present with normal right ventricular size on a surface echocardiogram (63.2% vs 54.8%, p = 0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, p = 0.04), but after adjustment, there was no sex-based survival difference. There were no sex differences in the PE-related diagnostic studies performed, use of advanced therapies, or short-term outcomes, before and after adjustment ( p > 0.05 for all). In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations compared with men. Despite these differences, there were no sex disparities in PE management or outcomes.

Safety and Clinical Utility of Four Clinical Decision Rules In the Diagnostic Management of Acute Pulmonary Embolism – the Prometheus Diagnosis Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3186-3186
Author(s):  
Inge CM Mos ◽  
Renée A Douma ◽  
Petra MG Erkens ◽  
Tessa AC Nizet ◽  
Marc F Durian ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Utility ◽  
Acute Pulmonary Embolism ◽  
Decision Rules ◽  
Clinical Decision ◽  
Clinical Decision Rules ◽  
Wells Rule ◽  
Revised Geneva Score ◽  
Acute Pe ◽  
D Dimer

Abstract Abstract 3186 Background Several clinical decision rules (CDRs) are available for the exclusion of acute pulmonary embolism (PE). This prospective multi-center study compared the safety and clinical utility of four CDRs (Wells rule, revised Geneva score, simplified Wells rule and simplified revised Geneva score) in excluding PE in combination with D-dimer testing. Methods Clinical probability of patients with suspected acute PE was assessed using a computerized based “black box”, which calculated all CDRs and indicated the next diagnostic step. A “PE unlikely” result according to all CDRs in combination with a normal D-dimer result excluded PE, while patients with “PE likely” according to at least one of the CDRs or an abnormal D-dimer result underwent CT-scanning. Patients in whom PE was excluded were followed for three months. Results 807 consecutive patients were included and PE prevalence was 23%. The number of patients categorized as “PE unlikely” ranged from 62% (simplified Wells rule) to 72% (Wells rule). Combined with a normal D-dimer level, the CDRs excluded PE in 22–24% of patients. The total failure rates of the CDR-D-dimer combinations were similar (1 failure, 0.5– 0.6%, upper 95% CI 2.9– 3.1%). Despite 30% of the patients had discordant CDR outcomes, PE was missed in none of the patients with discordant CDRs and a normal D-dimer result. Conclusions All four CDRs show similar safety and clinical utility for exclusion of acute PE in combination with a normal D-dimer level. With this prospective validation, the more straightforward simplified scores are ready for use in clinical practice. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Desire for Information and Preference for Participation in Treatment Decisions in Patients With Cancer Presenting to the Department of General Surgery in a Tertiary Care Hospital in India

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Sushmitha Dharani Sankar ◽  
Baskaran Dhanapal ◽  
Gomathi Shankar ◽  
Balamourougan Krishnaraj ◽  
Sandhya Karra ◽  
...  
Keyword(s):  
Decision Making ◽  
Information Needs ◽  
Group Performance ◽  
Performance Status ◽  
Tertiary Care ◽  
Eastern Cooperative Oncology Group ◽  
Treatment Decisions ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Patients With Cancer

Purpose Providing appropriate information to patients about their illness helps them to cope with the diagnosis. Shared decision making is a key concept in managing patients with cancer. There are no data available about the desire for information and preference for participation in treatment decisions among Indian patients with cancer. The objective of this study was to estimate the proportion of patients who have information needs and to study the patient preference for participation in treatment decisions and the factors associated with them. Methods A cross-sectional survey was conducted among patients with cancer older than 18 years. They were interviewed with a questionnaire after signing an informed consent. The association of sex, educational level, residence, diagnosis (type of cancer), Eastern Cooperative Oncology Group performance status, and treatment status with information needs and decision-making preference was analyzed using χ2 test Results Approximately 81% of patients said that they had an absolute need to know if the illness was cancer, and > 70% of patients either had an absolute need to know or would like to know about the prognosis, treatment options, and adverse effects. Regarding the decision-making preferences, 97% wanted their treating physicians to make the decision regarding their treatment, and 66% preferred to share decision making with their family. Conclusion The majority of the patients with cancer expressed a need for knowing whether they had cancer. When it comes to treatment decisions, most of them preferred a passive role, and the majority wanted to involve their families in the decision-making process. We recommend that the treating physician should elicit the patient’s preference in participating in treatment decisions and their preference about involving their family in making treatment decisions

scholarly journals Safety and Efficiency of the YEARS Diagnostic Algorithm for Pregnant Patients with Clinically Suspected Acute Pulmonary Embolism —the Artemis Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 419-419
Author(s):  
Liselotte M. Van Der Pol ◽  
Cecile Tromeur ◽  
Ingrid Bistervels ◽  
Thomas van Bemmel ◽  
Francis Couturaud ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pregnant Women ◽  
Failure Rate ◽  
Acute Pulmonary Embolism ◽  
Diagnostic Algorithm ◽  
Ct Scanning ◽  
Ct Scans ◽  
Acute Pe ◽  
D Dimer

Abstract Background Acute pulmonary embolism (PE) is the leading cause of maternal mortality in Western countries, accounting for 20 to 30% of all maternal deaths. Therefore, the threshold to test for PE during pregnancy is low. Because evidence regarding the safety of ruling out PE with clinical decision rules and D-dimer tests in pregnant women is unavailable, all women with a suspected PE need to undergo an imaging test, with potential harm to patient and fetus by exposure to ionizing radiation. In the present international, multicenter, prospective management study, we evaluated the safety and efficiency of the YEARS diagnostic algorithm for ruling out PE in pregnant patients with clinically suspected PE (Netherlands Trial Registry number 5913). YEARS is a simple diagnostic algorithm designed to reduce the number of required computed tomography (CT) scans in the diagnostic work-up of PE in non-pregnant patients, and was recently shown to be as safe as conventional algorithms but associated with a significant absolute 14% reduction in the number of CT scans (van der Hulle et al., Lancet 2017). Methods The Artemis study was performed in 11 Dutch hospitals, 8 French hospitals and 1 Irish hospital. Consecutive pregnant patients with suspected acute PE were included. Exclusion criteria were treatment with therapeutically dosed anticoagulants >24 hours or contraindications for CT. The YEARS algorithm was slightly adjusted for application during pregnancy (figure 1): in patients with signs of deep vein thrombosis (DVT), compression ultrasonography was obligatory before CT scanning was considered. In patients with proven DVT, anticoagulant treatment was initiated and no further diagnostic tests were undertaken. In patients with no YEARS items (Figure 1), a D-dimer threshold of <1.0 µg/ml was sufficient to rule out PE. In the remaining patients D-dimer threshold was <0.5 µg/mL. CT scanning was only performed in patients with a D-dimer level above the threshold. Anticoagulant therapy was withheld if PE was excluded. The primary safety endpoint was the occurrence of symptomatic venous thromboembolism during 3 months of follow-up, the primary efficiency endpoint was the proportion of patients in whom CTPA could be avoided. All safety endpoints were adjudicated by an independent committee. Assuming a 1.0% diagnostic failure rate and defining a maximum acceptable failure rate of 2.7%, a total study population of 472 patients was required (one-sided alpha 0.05, beta 80%). Results and conclusion: The last patient was included in May 2018. At baseline, 48% of pregnant women with suspected acute PE had no YEARS item and a D-dimer threshold of 1.0 µg/mL was applied. A total of 42% had a D-dimer level below the relevant threshold and were managed without CT scanning. Follow-up and endpoint adjudication was not completed at the abstract submission deadline; full study results will be presented at the ASH meeting. Disclosures Couturaud: Pfizer: Research Funding; Bayer: Honoraria, Other: Travel Support; AstraZeneca: Honoraria; Actelion: Other: Travel Support; Intermune: Other: Travel Support; Leo Pharma: Other: Travel Support; Daiichi Sankyo: Other: Travel Support.

scholarly journals D-dimer negative pulmonary embolism

2018 ◽  
Vol 5 (2) ◽  
pp. 429
Author(s):  
Dhananjaya M. ◽  
Kirankumar Meti ◽  
Rajendrakumar Parakh
Keyword(s):  
Pulmonary Embolism ◽  
Tertiary Care ◽  
Safety Margin ◽  
Final Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Care Hospital ◽  
Ct Pulmonary Angiography ◽  
The Mean ◽  
D Dimer

Background: Pulmonary embolism (PE), is one of the major cardiovascular causes of death. Pulmonary embolus (PE) can be fatal but is often treatable if recognized early. Unfortunately, the clinical presentation of PE is often variable and misleading mimicking other illnesses and hence known as "the Great Masquerader," making diagnosis difficult. The D-dimer assay has recently come into favour as a method to exclude PE; however, this test has an acceptable safety margin only in low-risk populations.Methods: Present study included 35 patients with clinical suspicion of pulmonary embolism admitted at the tertiary care hospital of North Karnataka during the period from October 2016 to September 2017. Patients were classified according to final diagnosis by CT Pulmonary Angiography into 28 cases positive for PE (80%) and 7 cases negative for PE (20%).Results: Present study included 35 cases suspected to have PE (26 males and 9 females). Their age ranged from 33 to 72 years, with a mean age 48.9 ±14.2 years. 28 cases positive for PE (80%) and 7 cases negative for PE (20%). The mean age of positive and negative PE cases was 48.1±11.2 and 46.4±8.8 respectively. Results of D-dimer test were positive in 10 cases (35.7%) and were negative in 18 cases (61.3 %) of PE.Conclusions: This report highlights the risk of misdiagnosing PE if relying solely on ELISA D-dimer for exclusion. This report documents the presentation of PE despite having unremarkable ELISA D-dimer measurements and highlights the importance of clinical suspicion.

Is there a link between lung parenchyma lesions , BMI , CRP , D-dimer and acute pulmonary embolism in patients infected with COVID-19 ?

2021 ◽  
Vol 21 ◽  
Author(s):  
Amer Hamadé ◽  
Lucas Jambert ◽  
Jonathan Tousch ◽  
Philippe Feuerstein ◽  
Karima Hammas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Lung Parenchyma ◽  
Lower Limbs ◽  
Nasopharyngeal Swab ◽  
Therapeutic Anticoagulation ◽  
Venous Thromboembolic Events ◽  
Acute Pe ◽  
D Dimer

Introduction: ince the outbreak of the COVID-19 pandemic , increasing suggests that infected patients present a high incidence of venous thromboembolic events (VTE). The main objective of this retrospective study was to evaluate the prevalence of acute pulmonary embolism (PE) on pulmonary computer tomography angiograms (CTPA) in patients classified as COVID-19 infection. The second objective was to determine if there is a link between D-dimer levels, serum C-reactive protein (CRP ), body mass index (BMI) , the lung parenchyma lesions (LPL) and acute pulmonary embolism (PE) in these patients. Material and Methods: 120 patients with mean age 65 ±14.5 years infected with COVID- 19 underwent in our institution a CTPA for suspected PE .Thirty four were in intensive care units (ICU). A COVID-19 diagnosis was made by transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest CT images. Demographics and co-morbidities characteristics were collected . Laboratory parameters were automatically extracted from our heath information system. When PE was suspected a CTPA were acquired after injection of high concentration iodine contrast media .The criterion of suspected PE were based on the clinical respiratory deterioration , with an increased need for oxygen. A venous duplex ultrasound (DU) test of lower limbs was performed on admission. Results: CTPA showed 24 acute PE (20%) , of which 11 primary and 13 associated with deep venous thrombosis diagnosed on DU .Eleven of the 24 (45.8 %)had PE despite preventive and therapeutic anticoagulation with low molecular weight heparin with Enoxaparin (7 with preventive anticoagulation and 4 had therapeutic dose), of them 8 (72.7%) with risk factors for VTE .Acute PE was not significantly associated with CRP and LPL. However , we found a significant association between acute PE and BMI (mean 32.41±5.90 versus 27.1± 5.2 kg/m2, p 0.0007) or D-dimer Levels (mean 6040±5068 versus 3396.7±5361.5 ng/ml ,p <0.0001). Conclusions: Hospitalized patients infected with COVID-19 in conventional units or ICU have a high frequency of PE justifying preventive anticoagulation. For those who have a risk factors for VTE a therapeutic anticoagulation may be indicated.

P5017Factors associated with a negative D-dimer test in patients diagnosed with acute symptomatic pulmonary embolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Barco ◽  
M Russo ◽  
F A Klok ◽  
S V Konstantinides
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
False Negative ◽  
Diagnostic Strategy ◽  
Inverse Association ◽  
Symptomatic Pulmonary Embolism ◽  
Post Hoc ◽  
Acute Pe ◽  
D Dimer

Abstract Background The recommended diagnostic strategy for suspected acute pulmonary embolism (PE) combines the assessment of pre-test probability, D-dimer level, and -if indicated- computed tomography pulmonary angiography. Purpose To evaluate the frequency and potential explanations for negative D-dimer tests in patients diagnosed with acute PE. Methods The multicentre Follow-up of Acute Pulmonary Embolism (FOCUS) cohort study prospectively enrolled 1,100 consecutive patients diagnosed with acute symptomatic PE; two-year follow-up is ongoing. The items of the Simplified revised Geneva Score and the D-dimer levels at diagnosis have been prospectively collected, but they did not necessarily guide management decisions. Quantitative D-dimer was measured on admission either by quantitative latex-based assays or enzyme-linked immunosorbent assays. A negative D-dimer was defined by fixed (0.50 μg/mL) or age-adjusted (age*0.01 μg/mL if age>50) cut-off. Results Using the fixed cut-off, a negative D-Dimer was detected in 17 of 773 patients with ultimately diagnosed PE (miss rate 2.2% [95% CI 1.4–3.5]); using the age-adjusted cut-off, the test was discordant with the PE diagnosis in 24 patients (3.1% [2.1–4.6]). In Figure 1, red dots indicate negative D-dimer test by fixed cut-off and blue dots indicate additional negative D-dimer tests by age-adjusted cut-off. In 448 (59%) patients post-hoc classified as PE-unlikely, 11 (2.5% [1.4–4.3]) and 14 (3.1% [1.9–5.2]) patients had a negative D-dimer using the two different cut-offs, respectively. Haemoptysis on admission, V/Q scan-based diagnosis, and chronic lung disease were associated with a discordant D-dimer, while an inverse association existed for concomitant DVT. In 7 (29%) PE cases with normal D-dimer, PE was verified to be subsegmental also in a post-hoc evaluation. Another seven (29%) patients were receiving anticoagulation at the time of D-dimer assessment. Figure 1 Conclusions Our results show that the frequency of discordance between a normal D-dimer test and the diagnosis of acute PE is low, but not negligible. One third of discordant findings were related to subsegmental PE. Physicians should be aware that the risk of obtaining a false-negative D-dimer might be higher in specific subgroups of patients. Acknowledgement/Funding The sponsor (University Medical Center of the Johannes Gutenberg University, Mainz) has obtained grants from Bayer Vital GmbH and Bayer Pharma AG

scholarly journals Symptom Duration Is Positively Correlated with Factor XIIIa Activity in Acute Pulmonary Embolism

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5047-5047
Author(s):  
Yevgeniy Brailovsky ◽  
Debra Hoppensteadt ◽  
Omer Iqbal ◽  
Kevin Simpson ◽  
Nathan Mcclane ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Critical Role ◽  
Tertiary Care ◽  
Response To Therapy ◽  
Factor Xiiia ◽  
Symptom Duration ◽  
The Impact ◽  
D Dimer

Abstract Background Acute pulmonary embolism (PE) patients are at variable risk of morbidity, mortality, and response to therapy. Patients often present at various time points from the symptom onset. Several factors may shed light into the state of endogenous thrombotic and fibrinolytic system at the time of presentation. Factor XIIIa plays a critical role in clot stabilization and may impact clot dissolution. Relation of Factor XIIIa activity and symptom duration is not known. Methods We prospectively collected blood samples from patients evaluated by Pulmonary Embolism Response Team at a tertiary care center. Blood was centrifuged, and plasma collected for analysis. We used ELISA method utilizing a commercially available kit from Hyphen, BioMed (Neuville-sur-Oise France), specific for measurement of Factor XIIIa, D-dimer, and Pro-TAFI antigens. Baseline clinical characteristics were collected from electronic medical record. Symptom duration was gathered from patient subjective assessment. Additional workup included radiographic and echocardiographic evaluation. We performed correlation analysis to test the association between symptom duration and Factor XIIIa activity, D-dimer, and Pro-TAFI antigen. Additionally we performed linear regression analyses to quantify the degree of association of symptom duration and Factor XIIIa activity. Results ±±9.8, 8 patients were treated with catheter directed thrombolysis, while the rest were treated with anticoagulation alone. Symptom duration was positively correlated with Factor XIIIa activity (r2=0.227). More so, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. (p=0.014). We demonstrated no correlation between symptom duration and D-Dimer (p=0.58) or symptom duration and Pro-TAFI antigen (p=0.84). Conclusion In patients with acute PE, symptom duration positively correlated with Factor XIIIa activity, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. Future studies are needed to ascertain the impact of Factor XIIIa activity and clot dissolution as well as functional outcomes. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical factors and outcomes of subsegmental pulmonary embolism in cancer patients

2021 ◽  
Vol 5 (4) ◽  
pp. 1050-1058
Author(s):  
Melissa Yan ◽  
Ryan Kieser ◽  
Carol C. Wu ◽  
Wei Qiao ◽  
Cristhiam M. Rojas-Hernandez
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Pulmonary Arteries ◽  
Cancer Center ◽  
Ecog Performance Status ◽  
Randomized Controlled Clinical Trials ◽  
Increased Risk

Abstract In the cancer population, patients diagnosed with venous thromboembolism (VTE) are considered to have a threefold increased risk of mortality compared with those without VTE. With the advent of modern computed tomography (CT), the rate of diagnosis of subsegmental pulmonary embolism (SSPE) has increased, likely as a result of improved visualization of the peripheral pulmonary arteries. The clinical significance of SSPE remains unclear because of the lack of randomized controlled clinical trials. The aim of this study was to identify the incidence and risk factors of recurrent proximal PE within 12 months of diagnosis of SSPE in cancer. We performed a retrospective analysis of 206 adult cancer patients who were diagnosed with SSPE from 2014 to 2016 at the University of Texas MD Anderson Cancer Center. At the time of SSPE diagnosis, the majority had metastatic cancer, 108 patients (53.2%) were undergoing chemotherapy, and 23 patients (11.2%) had a history of VTE. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. Sixty-seven percent of SSPE was discovered incidentally on restaging CT scans, with the majority being a single and isolated event (70.9%). Within 12 months of SSPE diagnosis, 18 patients (8.7%) were found to have a recurrent PE. The patients treated with anticoagulation had a lower rate of PE recurrence (8% vs 13% in those not treated with anticoagulation). Treatment with anticoagulation did not appear to have a significant impact on overall survival (P = .48) when adjusted for ECOG performance status and cancer stage.

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