TY - JOUR
T1 - Incidental pulmonary embolism in cancer and noncancer patients
T2 - Prospective cohort study
AU - Wysokinska, Ewa M.
AU - Houghton, Damon E.
AU - Vlazny, Danielle T.
AU - Ashrani, Aneel A.
AU - Froehling, David A.
AU - Meverden, Ryan
AU - Hodge, David O.
AU - Peterson, Lisa G.
AU - McBane, Robert D.
AU - Wysokinski, Waldemar E.
AU - Casanegra, Ana I.
N1 - Funding Information:
The authors would like to acknowledge the clinical and research staff at the Mayo Clinic thrombophilia Center for providing patient care and help in collecting the data used in the manuscript.
Funding Information:
Robert D. McBane has a research grant from Bristol Myers Squibb. Other authors declare no conflict of interest.
Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Clinical picture and outcome of incidental pulmonary embolism (iPE) compared to symptomatic pulmonary embolism (sPE) remain unclear. Methods: Demographics, recurrent venous thromboembolism (VTE), mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) were compared between iPE and sPE patients who were followed prospectively at Mayo Thrombophilia Clinic (March 1, 2013 to August 1, 2020). Results: Out of 3576 VTE patients, 1417 (39.6%) had PE: 562 (39.7%) iPE and 855 sPE. Patients with cancer were more likely to have iPE (400 iPE vs. 314 sPE) compared to those without cancer (162 iPE vs. 541 sPE). VTE recurrence rate (all per 100 person-years) was similar in all iPE and sPE patients (3.34 vs. 3.68, p =.50), with cancer (4.16 vs. 4.89, p =.370), and without cancer patients (0.89 vs. 2.80, p =.25). Higher mortality observed in all patients with iPE compared to sPE (46.45 vs. 23.47, p <.001) and with cancer (56.41 vs. 45.77, p =.03) became not significant after adjustment for age, antiplatelet therapy, metastases, and cancer location. Noncancer iPE patients had higher mortality (15.95 vs. 7.18, p =.006) even after adjustment (p =.05). The major bleeding rate was also higher in all patients iPE compared to sPE (7.10 vs. 3.68, p =.03), but not after adjustment (p =.974); higher major bleeding rate in noncancer patients (6.49 vs. 1.25, p =.007) remained significant after adjustment (.02). CRNMB rate was similar to iPE and sPE patients. Conclusion: iPE represents a more serious clinical condition compared to sPE as indicated by the higher mortality and major bleeding but these differences reflect underlying comorbidities rather than the seriousness of the embolic event.
AB - Background: Clinical picture and outcome of incidental pulmonary embolism (iPE) compared to symptomatic pulmonary embolism (sPE) remain unclear. Methods: Demographics, recurrent venous thromboembolism (VTE), mortality, major bleeding, and clinically relevant nonmajor bleeding (CRNMB) were compared between iPE and sPE patients who were followed prospectively at Mayo Thrombophilia Clinic (March 1, 2013 to August 1, 2020). Results: Out of 3576 VTE patients, 1417 (39.6%) had PE: 562 (39.7%) iPE and 855 sPE. Patients with cancer were more likely to have iPE (400 iPE vs. 314 sPE) compared to those without cancer (162 iPE vs. 541 sPE). VTE recurrence rate (all per 100 person-years) was similar in all iPE and sPE patients (3.34 vs. 3.68, p =.50), with cancer (4.16 vs. 4.89, p =.370), and without cancer patients (0.89 vs. 2.80, p =.25). Higher mortality observed in all patients with iPE compared to sPE (46.45 vs. 23.47, p <.001) and with cancer (56.41 vs. 45.77, p =.03) became not significant after adjustment for age, antiplatelet therapy, metastases, and cancer location. Noncancer iPE patients had higher mortality (15.95 vs. 7.18, p =.006) even after adjustment (p =.05). The major bleeding rate was also higher in all patients iPE compared to sPE (7.10 vs. 3.68, p =.03), but not after adjustment (p =.974); higher major bleeding rate in noncancer patients (6.49 vs. 1.25, p =.007) remained significant after adjustment (.02). CRNMB rate was similar to iPE and sPE patients. Conclusion: iPE represents a more serious clinical condition compared to sPE as indicated by the higher mortality and major bleeding but these differences reflect underlying comorbidities rather than the seriousness of the embolic event.
KW - cancer-associated thrombosis
KW - incidental pulmonary embolism
KW - venous thromboembolism
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U2 - 10.1111/ejh.13877
DO - 10.1111/ejh.13877
M3 - Article
C2 - 36210612
AN - SCOPUS:85140255929
SN - 0902-4441
VL - 110
SP - 88
EP - 98
JO - European Journal of Haematology
JF - European Journal of Haematology
IS - 1
ER -