Concomitant Deep Vein Thrombosis in Cancer Patients with Unsuspected Pulmonary Embolism.
Aiham Z QdaisatAdriana H WechslerMaria T Cruz CarrerasJazmin R MenendezDemis LipeEmily A HighsmithMona J KamalAisha Al-BreikiCristhiam Mauricio Rojas-HernandezCarol C WuSai-Ching Jim YeungPublished in: Cancers (2022)
Incidental venous thromboembolism (VTE) is common in cancer patients and identifying factors associated with these events can improve the management plan. We studied the characteristics of concomitant deep vein thrombosis (C-DVT) in cancer patients presenting with unsuspected pulmonary embolism (PE) and the association of C-DVT with VTE recurrence and survival outcomes. Patients presenting to our emergency department with confirmed unsuspected/incidental PE between 1 January 2006 and 1 January 2016, were identified. Radiologic reports were reviewed to confirm the presence or absence of C-DVT. Logistic regression analyses and cox regression modeling were used to determine the effect of C-DVT on VTE recurrence and survival outcomes. Of 904 eligible patients, 189 (20.9%) had C-DVT. Patients with C-DVT had twice the odds of developing VTE recurrence (odds ratio 2.07, 95% confidence interval 1.21-3.48, p = 0.007). The mortality rates among C-DVT were significantly higher than in patients without. C-DVT was associated with reduced overall survival in patients with unsuspected PE (hazard ratio 1.33, 95% confidence interval 1.09-1.63, p = 0.005). In conclusion, C-DVT in cancer patients who present with unsuspected PE is common and is associated with an increased risk of VTE recurrence and poor short- and long-term survival. Identifying other venous thrombi in cancer patients presenting with unsuspected PE is recommended and can guide the management plan. For patients with isolated incidental subsegmental pulmonary embolism and concomitant deep vein thrombosis, initiating anticoagulants if no contraindications exist is recommended.
Keyphrases
- pulmonary embolism
- venous thromboembolism
- end stage renal disease
- emergency department
- ejection fraction
- newly diagnosed
- inferior vena cava
- chronic kidney disease
- peritoneal dialysis
- papillary thyroid
- prognostic factors
- direct oral anticoagulants
- squamous cell
- cardiovascular events
- coronary artery disease
- cardiovascular disease
- risk factors
- lymph node metastasis