Does anticoagulation needed for distally located incidental pulmonary thromboembolism in patients with active cancer?
Autoři:
Haseong Chang aff001; Min Sun Kim aff001; Su Yeon Lee aff001; Sun Hye Shin aff002; Hye Yun Park aff002; Sung-A Chang aff001; Taek Kyu Park aff001; Duk-Kyung Kim aff001; Eun Kyoung Kim aff001
Působiště autorů:
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
aff001; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
aff002
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222149
Souhrn
Background
Incidental pulmonary embolism (IPE) is frequently detected in of cancer patients undergoing CT scans for staging work up or treatment response evaluation. Nevertheless, the optimal management of IPE remains unknown. Thus, we aimed to evaluate the clinical manifestations of IPE in cancer patients and to compare the clinical prognosis according to anticoagulation therapy.
Methods
We retrospectively analyzed medical records of cancer patients with newly diagnosed PE between March 2010 and December 2013. Baseline demographics, comorbidities, cancer status and clinical presentation of PE were recorded. We compared all cause death, recurrent venous thromboembolism and clinically relevant bleeding events in those with PE. Survival analysis was performed to assess effect of anticoagulation on IPE.
Results
Among 703 cancer patients diagnosed with PE, IPE was identified in 474 (67.3%) patients. Compared to symptomatic patients, those with IPE had more advanced malignancy, were more likely to be on current chemotherapy at the time of IPE diagnosis. These patients tend to have smaller embolic burden, as demonstrated by the lower rate of bilateral lung involvement and RV dysfunction. While symptomatic PE showed better survival with anticoagulation (median survival 6.0 vs. 17.3 months, p = 0.003), anticoagulation did not result in significant survival benefit in IPE (median survival 15.1 vs. 21.3, p = 0.225). However, in subgroup analysis, there was significant improvement in survival with anticoagulation in patients with proximal IPE (median survival 12.2 vs. 23.4 months, p = 0.023), but not in patients with distal IPE (21.2 vs. 15.1, p = 0.906).
Conclusions
In cancer patients who were diagnosed with IPE, the overall survival was different according to the embolic burden and anticoagulation therapy.
Klíčová slova:
Medicine and health sciences – Oncology – Cancer treatment – Vascular medicine – Thromboembolism – Venous thromboembolism – Deep vein thrombosis – Diagnostic medicine – Diagnostic radiology – Tomography – Computed axial tomography – Signs and symptoms – Cancer detection and diagnosis – Radiology and imaging – Pathology and laboratory medicine – Hemorrhage – Cardiovascular anatomy – Blood vessels – Arteries – Pulmonary arteries – Research and analysis methods – Imaging techniques – Biology and life sciences – Neuroscience – Neuroimaging – Anatomy
Zdroje
1. Liebman H.A. and O'Connell C., Incidental venous thromboembolic events in cancer patients: what we know in 2016. Thromb Res, 2016. 140 Suppl 1: p. S18–20.
2. Heit J.A., O'Fallon W.M., Petterson T.M., Lohse C.M., Silverstein M.D., Morhr D.N., et al., Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med, 2002. 162(11): p. 1245–8. doi: 10.1001/archinte.162.11.1245 12038942
3. van Es N., Bleker S.M., and Di Nisio M., Cancer-associated unsuspected pulmonary embolism. Thromb Res, 2014. 133 Suppl 2: p. S172–8.
4. Khorana A.A., Francis C.W., Culakova E., Kuderer N.M., Lyman G.H., Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost, 2007. 5(3): p. 632–4. doi: 10.1111/j.1538-7836.2007.02374.x 17319909
5. Di Nisio M., Lee A.Y., Carrier M., Liebman H.A., Khorana A.A., Diagnosis and treatment of incidental venous thromboembolism in cancer patients: guidance from the SSC of the ISTH. J Thromb Haemost, 2015. 13(5): p. 880–3. doi: 10.1111/jth.12883 25714858
6. Konstantinides S.V., 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014. 35(45): p. 3145–6. doi: 10.1093/eurheartj/ehu393 25452462
7. Pruthi R.K., Review of the American College of Chest Physicians 2012 Guidelines for Anticoagulation Therapy and Prevention of Thrombosis. Semin Hematol, 2013. 50(3): p. 251–8. doi: 10.1053/j.seminhematol.2013.06.005 23953342
8. Sun J.M., Kim T.S., Lee J., Park Y.H., Ahn J.S., Kim H., Kwon O.J., Lee K.S., Park K., Ahn M.J., Unsuspected pulmonary emboli in lung cancer patients: the impact on survival and the significance of anticoagulation therapy. Lung Cancer, 2010. 69(3): p. 330–6. doi: 10.1016/j.lungcan.2009.11.015 20007002
9. Schulman S. and Kearon C., Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost, 2005. 3(4): p. 692–4. doi: 10.1111/j.1538-7836.2005.01204.x 15842354
10. Shinagare A.B., Okajima Y., Oxnard G.R., Dipiro P.J., Johnson B.E., Hataby H., et al., Unsuspected pulmonary embolism in lung cancer patients: comparison of clinical characteristics and outcome with suspected pulmonary embolism. Lung Cancer, 2012. 78(2): p. 161–6. doi: 10.1016/j.lungcan.2012.08.007 22959241
11. den Exter P.L., Kroft L.J., van der Hulle T., Klok F.A., Jimenz D., Huisman M.V., Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients. J Thromb Haemost, 2013. 11(8): p. 1620–2. doi: 10.1111/jth.12325 23782874
12. Font C., Carmona-Bayonas A., Beato C., Reig O., Saez A., Jimenez-Fonseca P., et al., Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study. Eur Respir J, 2017. 49(1).
13. van der Hulle T., den Exter P.L., Planquette B., Meyer G., Soler S., Monreal M.,et al., Risk of recurrent venous thromboembolism and major hemorrhage in cancer-associated incidental pulmonary embolism among treated and untreated patients: a pooled analysis of 926 patients. J Thromb Haemost, 2016. 14(1): p. 105–13. doi: 10.1111/jth.13172 26469193
14. Cesarman-Maus G. and Ruiz-Arguelles G.J., News in the Indications of Direct Oral Anticoagulants According to the American College of Chest Physicians 2016 Guidelines. Curr Drug Metab, 2017. 18(7): p. 651–656. doi: 10.2174/1389200218666170413154226 28412908
Článek vyšel v časopise
PLOS One
2019 Číslo 9
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