Intensify Standardized Anticoagulation for Cancer-Associated Pulmonary Embolism: From Single-Center Real-World Data

• Published in: Clinical therapeutics 2023-12, Vol.45 (12), p.1236-1243
• Main Authors: Liu, Mingjie, Qiu, Xianming, Sun, Yuanyuan, Li, Qi, Wen, Jing, Liu, Guixiang, Yao, Zhouhong, Zhu, Ling
• Format: Article
• Language: English
• Subjects: All-cause mortality; Anticoagulant treatment; Anticoagulants; Bleeding; Blood clots; Body mass index; Cancer; Cancer therapies; Cancer-associated pulmonary embolism; Clinical outcomes; Drug dosages; Embolism; Heart; Hemoglobin; Lung cancer; Mortality; Oncology; Patients; Prognosis; Pulmonary arteries; Pulmonary embolisms; Quality of life; Recurrent venous thromboembolism; Regression analysis; Risk factors; Survival analysis; Thromboembolism; Thrombosis; Ultrasonic imaging; Ventricle
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2023.09.014

Pulmonary embolism (PE) is a significant contributor to mortality in patients with cancer. Although anticoagulation serves as the cornerstone of treatment for cancer-associated PE, it has not been emphasized in real-world settings. The aim of this study was to examine the impact of suboptimal anticoagulant treatment on the prognosis of cancer-associated PE. A cohort of 356 individuals newly diagnosed with acute PE were enrolled. The primary outcome of the study was recurrent venous thromboembolism (VTE), and the secondary outcomes were all-cause mortality and major bleeding (consisting of a reduction in the hemoglobin level by at least 20 g/L, transfusion of at least 2 units of blood, or symptomatic bleeding in a critical area or organ or fatal bleeding). Of the total participants, 156 (43.8%) were diagnosed with cancer. A comparison between the cancer and noncancer groups revealed that patients with cancer were more frequently asymptomatic (41.0% vs 4.5%; P < 0.001), less likely to have right ventricular dysfunction (4.5% vs 14.0%; P = 0.001), received less anticoagulant treatment during hospitalization (85.3% vs 98.5%; P < 0.001), and had a shorter duration of anticoagulation (5.02 [7.40] months vs 14.19 [10.65] months; P < 0.001). In addition, patients with cancer were found to be at a higher risk of recurrent VTE (17.3% vs 4.0%; P < 0.001) and all-cause mortality (23.7% vs 10.5%; P = 0.001). Multiple Cox regression analysis indicated that discontinuation of anticoagulation at 3 months was a significant risk factor for recurrent VTE in the cancer group (HR, 15.815; 95% CI, 3.047–82.079; P = 0.001). The brief duration of anticoagulation therapy and elevated likelihood of recurrent VTE serve as cautionary indicators for the need to enhance awareness of standardized anticoagulant treatment for cancer-associated PE. The ultimate goal is to enhance patient prognosis and quality of life.