Anticoagulants Not Effective in Managing Recurrent PE After Subsegmental Pulmonary Embolism - Oncology Nurse Advisor
Anticoagulant therapy did not affect overall survival among patients with cancer. These findings, from a retrospective study, were published in Blood Advances.
Diagnosis of subsegmental pulmonary embolism (SSPE) in patients with cancer has increased, perhaps due to improved imaging of the peripheral pulmonary arteries. SSPE in patients with cancer is associated with high recurrence of pulmonary embolism (PE); however, the significance of this is unknown. Therefore, researchers at the University of Texas MD Anderson Cancer Center sought to determine the incidence and risk factors of recurrent PE within 12 months of SSPE diagnosis.
Electronic medical records from 206 patients with cancer and subsegmental pulmonary embolism (SSPE) treated at the center between 2014 and 2016 were assessed for instances of pulmonary embolism, anticoagulant therapy, and clinical outcomes.
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Of the participants, 42.2% were women, median age 62 years (range, 19 to 90); the most common cancer types were lung (18.9%), colorectal (8.7%), breast (8.7%), hematologic (8.3%), and urologic (8.3%) cancers.
After diagnosis of SSPE, 151 patients were started on anticoagulation therapy (59.7% received low-molecular-weight heparin), 15 did not receive any therapy, and 9 were managed by an inferior vena cava interruption device.
At 1 year, 8.7% had recurrent SSPE or a new proximal PE. The rate of PE recurrent events was elevated among patients not receiving anticoagulant therapy (13% vs 8%); however, the rate of cumulative PE incidence did not differ between patient groups (P =.585).
Among patients treated with anticoagulants, 5.3% had major and 7.3% had nonmajor bleeding events.
Overall survival was associated with Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 6.345; 95% CI, 3.614-11.139; P <.0001) and American Joint Committee on Cancer stage (HR, 5.031; 95% CI, 2.386-10.604; P <.0001) but not with anticoagulant therapy (HR, 0.818; 95% CI, 0.469-1.428; P =.4799).
This study may have been limited by the size imbalance between treatment cohorts.
These data indicated anticoagulant therapy did not improve overall survival among patients with cancer and SSPE but did increase bleeding events.
Reference
Yan M, Kieser R, Wu CC, Qiao W, Rojas-Hernandez CM. Clinical factors and outcomes of subsegmental pulmonary embolism in cancer patients. Blood Adv. 2021;5(4):1050-1058. doi:10.1182/bloodadvances.2020003136
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