Vol 79, No 12 (2021)
Review paper
Published online: 2021-11-29

open access

Page views 7016
Article views/downloads 2042
Get Citation

Connect on Social Media

Connect on Social Media

How to treat incidental pulmonary embolism in cancer patients? Recent advances

Aurélien Delluc1, Tzu-Fei Wang1
Pubmed: 34845714
Kardiol Pol 2021;79(12):1305-1310.

Abstract

Patients with cancer have an increased risk of venous thromboembolism (VTE). In addition, due to the growing use of computed tomography scans in these patients and the improved scanners and imaging qualities, many cases of VTE are diagnosed incidentally on images obtained for reasons other than suspicion of VTE. Studies have shown that as many as half of all cancer-related pulmonary embolism (PE) cases could be incidental. Despite the common occurrence, the optimal management of incidental PE in patients with cancer remains unclear. This review will summarize pertinent literature related to incidental PE in the cancer population and discuss their outcomes and recommended treatments.

References

  1. Shteinberg M, Segal-Trabelsy M, Adir Y, et al. Clinical characteristics and outcomes of patients with clinically unsuspected pulmonary embolism versus patients with clinically suspected pulmonary embolism. Respiration. 2012; 84(6): 492–500.
  2. Spirk D, Sebastian T, Barco S, et al. Clinical outcomes of incidental venous thromboembolism in cancer and noncancer patients: The SWiss Venous ThromboEmbolism Registry (SWIVTER). Thromb Haemost. 2021; 121(5): 641–649.
  3. van Es N, Bleker SM, Di Nisio M. Cancer-associated unsuspected pulmonary embolism. Thromb Res. 2014; 133 Suppl 2: S172–S178.
  4. Caiano L, Carrier M, Marshall A, et al. Outcomes among patients with cancer and incidental or symptomatic venous thromboembolism: A systematic review and meta-analysis. J Thromb Haemost. 2021; 19(10): 2468–2479.
  5. Meyer HJ, Wienke A, Surov A. Incidental pulmonary embolism in oncologic patients-a systematic review and meta-analysis. Support Care Cancer. 2021; 29(3): 1293–1302.
  6. Lee AYY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003; 349(2): 146–153.
  7. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020; 382(17): 1599–1607.
  8. Kraaijpoel N, Di Nisio M, Mulder FI, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018; 378(7): 615–624.
  9. Young AM, Marshall A, Thirlwall J, et al. Comparison of an oral factor xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018; 36(20): 2017–2023.
  10. Mulder FI, Di Nisio M, Ay C, et al. Clinical implications of incidental venous thromboembolism in cancer patients. Eur Respir J. 2020; 55(2).
  11. Giustozzi M, Connors JM, Ruperez Blanco AB, et al. Clinical characteristics and outcomes of incidental venous thromboembolism in cancer patients: Insights from the Caravaggio study. J Thromb Haemost. 2021; 19(11): 2751–2759.
  12. Khorana AA, O'Connell C, Agnelli G, et al. Incidental venous thromboembolism in oncology patients. J Thromb Haemost. 2012; 10(12): 2602–2604.
  13. Kraaijpoel N, Bleker SM, Meyer G, et al. Treatment and long-term clinical outcomes of incidental pulmonary embolism in patients with cancer: an international prospective cohort study. J Clin Oncol. 2019; 37(20): 1713–1720.
  14. Font C, Carmona-Bayonas A, Beato C, 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).
  15. O'Connell CL, Boswell WD, Duddalwar V, et al. Unsuspected pulmonary emboli in cancer patients: clinical correlates and relevance. J Clin Oncol. 2006; 24(30): 4928–4932.
  16. O'Connell CL, Razavi PA, Liebman HA. Symptoms adversely impact survival among patients with cancer and unsuspected pulmonary embolism. J Clin Oncol. 2011; 29(31): 4208–9; author reply 4209.
  17. Maraveyas A, Kraaijpoel N, Bozas G, et al. The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study. J Thromb Haemost. 2021; 19(11): 2791–2800.
  18. van der Hulle T, den Exter PL, Planquette B, 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): 105–113.
  19. Browne AM, Cronin CG, English C, et al. Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging. J Thorac Oncol. 2010; 5(6): 798–803.
  20. Auer RC, Schulman AR, Tuorto S, et al. Use of helical CT is associated with an increased incidence of postoperative pulmonary emboli in cancer patients with no change in the number of fatal pulmonary emboli. J Am Coll Surg. 2009; 208(5): 871–878.
  21. Jia CF, Li YX, Yang ZQ, et al. Prospective evaluation of unsuspected pulmonary embolism on coronary computed tomographic angiography. J Comput Assist Tomogr. 2012; 36(2): 187–190.
  22. Ritchie G, McGurk S, McCreath C, et al. Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax. 2007; 62(6): 536–540.
  23. Di Nisio M, Carrier M. Incidental venous thromboembolism: is anticoagulation indicated? Hematology Am Soc Hematol Educ Program. 2017; 2017(1): 121–127.
  24. Klok FA, Huisman MV, van der Hulle T, et al. Physicians' management approach to an incidental pulmonary embolism: an international survey. J Thromb Haemost. 2013; 11(1): 208–213.
  25. Le Ga, Kovacs M, Couturaud F, et al. The Management of SubSegmental Pulmonary Embolism without Anticoagulation [abstract]. Res Pract Thromb Haemost. 2021; 5(Suppl 2).
  26. Yan M, Kieser R, Wu CC, et al. Clinical factors and outcomes of subsegmental pulmonary embolism in cancer patients. Blood Adv. 2021; 5(4): 1050–1058.
  27. Bernstein R, Haim N, Brenner B, et al. Venous sonography for the diagnosis of asymptomatic deep vein thrombosis in patients with cancer undergoing chemotherapy. J Ultrasound Med. 2004; 23(5): 655–658.
  28. Khorana AA, Rubens D, Francis CW. Screening high-risk cancer patients for VTE: a prospective observational study. Thromb Res. 2014; 134(6): 1205–1207.
  29. Loftus JR, Hu Z, Morin BR, et al. Vascular imaging in the asymptomatic high-risk cancer population: a role for thrombosis screening and therapy management. J Ultrasound Med. 2021 [Epub ahead of print].
  30. Kitayama H, Kondo T, Sugiyama J, et al. Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study. BMC Cancer. 2017; 17(1): 351.
  31. Khorana AA, McNamara MG, Kakkar AK, et al. Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer. N Engl J Med. 2019; 380(8): 720–728.
  32. Pena E, Kimpton M, Dennie C, et al. Difference in interpretation of computed tomography pulmonary angiography diagnosis of subsegmental thrombosis in patients with suspected pulmonary embolism. J Thromb Haemost. 2012; 10(3): 496–498.
  33. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl): e419S–e496S.
  34. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016; 149(2): 315–352.
  35. Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021 [Epub ahead of print].
  36. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020; 38(5): 496–520.
  37. Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021; 5(4): 927–974.
  38. Khorana AA, Noble S, Lee AYY, et al. Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2018; 16(9): 1891–1894.
  39. Mahé I, Agnelli G, Ay C, et al. Extended anticoagulant treatment with full- or reduced-dose apixaban in patients with cancer-associated venous thromboembolism: rationale and design of the API-CAT study. Thromb Haemost. 2021 [Epub ahead of print].



Polish Heart Journal (Kardiologia Polska)