In patients with cancer with incidental pulmonary embolism (PE), risk of recurrent venous thromboembolism (VTE) is significant despite anticoagulant treatment, according to a study published the Journal of Clinical Oncology.
PE is incidentally diagnosed in up to 5 per cent of patients with cancer on routine imaging scans. However, the clinical relevance and optimal therapy for incidental PE, particularly distal clots, is unclear.
This international, prospective, observational cohort study included 695 adults with active cancer and a recent diagnosis of incidental PE. Outcomes were recurrent VTE, major bleeding and all-cause mortality during 12 months of follow-up.
Most frequent cancer types were colorectal (21%) and lung cancer (15%).
Anticoagulant therapy was initiated in 675 patients (97%), of whom 600 (89%) were treated with low-molecular-weight heparin.
Recurrent VTE occurred in 41 patients (12-month cumulative incidence 6.0%; 95% CI 4.4%-8.1%), major bleeding in 39 patients (12-month cumulative incidence 5.7%; 95% CI 4.1%-7.7%) and 283 patients died (12-month cumulative incidence 43%; 95% CI 39%-46%).
The authors concluded that patients with cancer with incidental PE have a high risk of recurrent VTE despite anticoagulant treatment, which strengthens current guideline advice to treat incidental PE as symptomatic PE for at least three to six months.