Acute pulmonary embolism in cancer patients admitted to intensive care unit: Impact of anticoagulant treatment on 90-day mortality and risk factors, results of a multicentre retrospective study

• Published in: Thrombosis research 2024-05, Vol.237, p.129-137
• Main Authors: Mokart, Djamel, Serre, Edouard, Bruneel, Fabrice, Kouatchet, Achille, Lemiale, Virginie, Chow-Chine, Laurent, Faucher, Marion, Sannini, Antoine, Valade, Sandrine, Bisbal, Magali, Gonzalez, Frederic, Servan, Luca, Darmon, Michaël, Azoulay, Elie
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute pulmonary embolism; Acute respiratory failure; Aged; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Cancer; Female; France - epidemiology; Hemorrhage - chemically induced; Hemorrhage - mortality; Heparin - adverse effects; Heparin - therapeutic use; Heparin, Low-Molecular-Weight - adverse effects; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Intensive care unit; Intensive Care Units; Low-molecular-weight heparins; Male; Middle Aged; Neoplasms - complications; Neoplasms - drug therapy; Neoplasms - mortality; Pulmonary Embolism - drug therapy; Pulmonary Embolism - mortality; Retrospective Studies; Risk Factors; Unfractionated heparins
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2024.03.027

Acute pulmonary embolism (PE) is a life-threatening situation in cancer patients. In this situation, anticoagulant therapy is complex to administer due to the risk of bleeding. Only few studies have been conducted when these patients are admitted to the intensive care unit (ICU). The aim of this study was to assess the association between anticoagulation strategies as well as other factors with 90-day mortality in patients with cancer and PE admitted to ICU. Major bleeding was also evaluated according to the type of anticoagulation. Retrospective study carried out in 4 ICUs in France over a 12-year period (2009–2021). All patients with cancer and PE were included. An overlap propensity score weighting analysis was performed in the subgroup of patients treated with either unfractionated heparins (UFH) alone or low-molecular-weight heparins (LMWH) alone on 90-day mortality and major bleeding. A total of 218 consecutive cancer patients admitted to ICU and presenting PE were included. The 90-day mortality rate was 42 % for the global cohort. After propensity score analysis in the subgroup of patients treated with either “UFH alone” (n = 80) or “LMWH alone” (n = 71), the 90-day mortality was similar in patients treated with UFH alone (42.6 %) vs LMWH alone (39.9 %): OR = 1.124, CI 95 % [0.571–2.214], p = 0.750. There was a significant increased toward major bleeding rates in the “UFH alone” group (25.5 %) as compared to “LMWH alone” group (11.5 %), p = 0.04. In 218 patients admitted to ICU and presenting PE, the 90-day mortality rate was 42 %. Treatment with UFH alone was associated with a mortality comparable to treatment with LMWH alone but it appeared to be more prone to major bleeding. •UFH alone is associated with a mortality comparable to treatment with LMWH alone.•UFH alone seems to be more prone to major bleeding.•Metastatic cancer and thrombocytopenia are independently associated with mortality.•Pulmonary embolism diagnosed in the early postoperative period is associated with a good outcome.