Faculty Opinions recommendation of Risk of recurrent venous thromboembolism and mortality in patients with cancer incidentally diagnosed with pulmonary embolism: a comparison with symptomatic patients.

Purpose The routine use of modern computed tomography scanners has led to an increased detection of incidental pulmonary embolism (PE), in particular in patients with cancer. The clinical relevance of these incidental findings is unknown. Patients and Methods In this retrospective cohort study, oncology patients in whom PE was objectively proven between 2004 and 2010 and anticoagulant treatment was started, were included. Fifty-one patients with incidental PE and 144 with symptomatic PE were observed for 1 year to compare the risks of recurrent venous thromboembolism (VTE), bleeding complications, and mortality. Kaplan-Meier and Cox survival analyses were performed. Results Incidental and symptomatic patients did not differ with respect to mean age, sex, cancer type and stage, and risk factors for VTE. As a result from evolving treatment guidelines, approximately half of the patients in both groups received long-term treatment with vitamin K antagonists in stead of currently recommended low-molecular-weight heparin. The 12-month cumulative incidence of recurrent VTE was 13.3% in the incidental group versus 16.9% in the symptomatic group (P = .77). Notably, 20% VTE events recurred after premature termination of anticoagulant therapy. The risk of major bleeding complications was also comparable in the two groups (12.5% for incidental patients and 8.6% for symptomatic patients; P = .5). The respective 12-month mortality risks were 52.9% and 53.3% (P = .7). Conclusion Our findings suggest that oncology patients diagnosed with and treated for incidental PE, have similar high rates of recurrent VTE, bleeding complications, and mortality, as compared with oncology patients who develop symptomatic PE.

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Treatment and Long-Term Clinical Outcomes of Incidental Pulmonary Embolism in Patients With Cancer: An International Prospective Cohort Study

Journal of Clinical Oncology ◽

10.1200/jco.18.01977 ◽

2019 ◽

Vol 37 (20) ◽

pp. 1713-1720 ◽

Cited By ~ 29

Author(s):

Noémie Kraaijpoel ◽

Suzanne M. Bleker ◽

Guy Meyer ◽

Isabelle Mahé ◽

Andrés Muñoz ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cohort Study ◽

Venous Thromboembolism ◽

Clinical Outcomes ◽

Major Bleeding ◽

Cumulative Incidence ◽

Patients With Cancer ◽

Incidental Pulmonary Embolism ◽

Recurrent Venous Thromboembolism

PURPOSE Pulmonary embolism is incidentally diagnosed in up to 5% of patients with cancer on routine imaging scans. The clinical relevance and optimal therapy for incidental pulmonary embolism, particularly distal clots, is unclear. The aim of the current study was to assess current treatment strategies and the long-term clinical outcomes of incidentally detected pulmonary embolism in patients with cancer. PATIENTS AND METHODS We conducted an international, prospective, observational cohort study between October 22, 2012, and December 31, 2017. Unselected adults with active cancer and a recent diagnosis of incidental pulmonary embolism were eligible. Outcomes were recurrent venous thromboembolism, major bleeding, and all-cause mortality during 12 months of follow-up. Outcome events were centrally adjudicated. RESULTS A total of 695 patients were included. Mean age was 66 years and 58% of patients were male. Most frequent cancer types were colorectal (21%) and lung cancer (15%). Anticoagulant therapy was initiated in 675 patients (97%), of whom 600 (89%) were treated with low-molecular-weight heparin. Recurrent venous thromboembolism occurred in 41 patients (12-month cumulative incidence, 6.0%; 95% CI, 4.4% to 8.1%), major bleeding in 39 patients (12-month cumulative incidence, 5.7%; 95% CI, 4.1% to 7.7%), and 283 patients died (12-month cumulative incidence, 43%; 95% CI, 39% to 46%). The 12-month incidence of recurrent venous thromboembolism was 6.4% in those with subsegmental pulmonary embolism compared with 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio, 1.1; 95% CI, 0.37 to 2.9; P = .93). CONCLUSION 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.

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Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: a systematic review of observational and intervention studies

Blood Coagulation & Fibrinolysis ◽

10.1097/mbc.0b013e328341f030 ◽

2011 ◽

Vol 22 (2) ◽

pp. 86-91 ◽

Cited By ~ 53

Author(s):

Martha L Louzada ◽

Habeeb Majeed ◽

Vi Dao ◽

Philip S Wells

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Intervention Studies ◽

Patients With Cancer ◽

Recurrent Venous Thromboembolism ◽

Cancer Associated Thrombosis

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Choice of Anticoagulant for Prevention of Recurrent Venous Thromboembolism in Patients with Cancer

50 Studies Every Internist Should Know ◽

10.1093/med/9780199349937.003.0012 ◽

2015 ◽

pp. 75-80

Author(s):

Laalitha Surapaneni

Keyword(s):

Venous Thromboembolism ◽

Patients With Cancer ◽

Recurrent Venous Thromboembolism

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Recurrent thrombosis followed by Lazarus response in ROS1 rearranged NSCLC treated with crizotinib: a case report

Tumori Journal ◽

10.1177/0300891620905665 ◽

2020 ◽

Vol 106 (6) ◽

pp. NP41-NP45

Author(s):

Teresa Beninato ◽

Giuseppe Lo Russo ◽

Marina Chiara Garassino ◽

Filippo De Braud ◽

Marco Platania

Keyword(s):

Venous Thromboembolism ◽

Genetic Alterations ◽

Small Cell Lung ◽

Recurrent Thrombosis ◽

Right Heart ◽

Thromboembolic Risk ◽

Patients With Cancer ◽

Recurrent Venous Thromboembolism ◽

Progressive Respiratory Failure ◽

Alk Positive

Introduction: Patients with cancer have higher risk of thrombosis compared to the general population and particularly lung adenocarcinoma is considered at high risk for venous thromboembolism. Some targetable oncogenic drivers are supposed to further increase this risk. Case description: A 35-year-old man who had developed a recurrent venous thromboembolism and pulmonary embolism (PE) was diagnosed with ROS1 rearranged non-small cell lung cancer (NSCLC). While molecular examinations were ongoing, he developed progressive respiratory failure. For PE and thrombosis worsening with detection of right heart thrombus, he underwent therapy with unfractionated heparin. Despite initial good radiologic results, only with the start of crizotinib did the patient’s clinical condition significantly improve to configure a Lazarus response. Conclusions: Cancer diagnosis should always be considered in patients with unprovoked thrombosis and, if NSCLC is diagnosed, genetic alterations should be always sought after. A possible relation between venous thromboembolism and oncogenic drivers, particularly for ALK translocations, has been hypothesized. Similarly to ALK-positive NSCLC, ROS1 rearranged disease has been associated with an increased thromboembolic risk. Further studies are needed to better evaluate this relation and to evaluate the potential benefit of a prophylactic anticoagulating treatment in this subset of patients.

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