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1. Risk assessment tools for bleeding in patients with unprovoked venous thromboembolism: an analysis of the PLATO-VTE study

Author

Guman, Noori A.M., Becking, Anne-Marie L., Weijers, Suzanne S., Kraaijpoel, Noémie, Mulder, Frits I., Carrier, Marc, Jara-Palomares, Luis, Di Nisio, Marcello, Ageno, Walter, Beyer-Westendorf, Jan, Klok, Frederikus A., Vanassche, Thomas, Otten, Johannes M.M.B., Cosmi, Benilde, Peters, Mike J.L., Wolde, Marije ten, Delluc, Aurélien, Sanchez-Lopez, Veronica, Porreca, Ettore, Bossuyt, Patrick M.M., Gerdes, Victor E.A., Büller, Harry R., van Es, Nick, and Kamphuisen, Pieter W.

Published
2024
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5. Inhibition of thrombin-activatable fibrinolysis inhibitor via DS-1040 to accelerate clot lysis in patients with acute pulmonary embolism: a randomized phase 1b study

Author

Huisman, Menno, Tapson, Victor, Grosso, Michael, Segers, Annelise, Ageno, Walter, Brodmann, Marianne, Jimenez, David, Meyer, Guy, Middeldorp, Saskia, Rosovsky, Rachel, Schellong, Sebastian, Verhamme, Peter, Büller, Harry, Bossuyt, Patrick, van Es, Nick, Vanassche, Thomas, Rosovsky, Rachel P., Moustafa, Fares, Büller, Harry R., Patel, Indu, Shi, Minggao, Miyoshi, Naoki, Mani, Venkatesh, Fayad, Zahi, Stephan, Dominique, Schmidt, Jeannot, Grosso, Michael A., Tapson, Victor F., and Huisman, Menno V.

Published
2023
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6. Platelet RNA sequencing for cancer screening in patients with unprovoked venous thromboembolism: a prospective cohort study

Author

Mulder, Frits I., Kraaijpoel, Noémie, Carrier, Marc, Guman, Noori A., Jara-Palomares, Luis, Di Nisio, Marcello, Ageno, Walter, Beyer-Westendorf, Jan, Klok, Frederikus A., Vanassche, Thomas, Otten, Hans-Martin B., Cosmi, Benilde, Wolde, Marije ten, In ‘t Veld, Sjors G.J. G., Post, Edward, Ramaker, Jip, Zwaan, Kenn, Peters, Mike, Delluc, Aurélien, Kamphuisen, Pieter W., Sanchez-Lopez, Veronica, Porreca, Ettore, Bossuyt, Patrick M.M., Büller, Harry R., Wurdinger, Thomas, Best, Myron G., and van Es, Nick

Published
2023
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8. Evaluation of the Khorana, PROTECHT, and 5‐SNP scores for prediction of venous thromboembolism in patients with cancer

Author

Guman, Noori A.M., van Geffen, Roos J., Mulder, Frits I., van Haaps, Thijs F., Hovsepjan, Vahram, Labots, Mariette, Cirkel, Geert A., de Vos, Filip Y.F.L., Ten Tije, Albert J., Beerepoot, Laurens V., Tjan‐Heijnen, Vivianne C.G., van Laarhoven, Hanneke W.M., Hamberg, Paul, Vulink, Annelie J.E., Los, Maartje, Zwinderman, Aeilko H., Ferwerda, Bart, Lolkema, Martijn P.J.K., Steeghs, Neeltje, Büller, Harry R., Kamphuisen, Pieter W., and van Es, Nick

Published
2021
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11. Long‐term risk of recurrent venous thromboembolism among patients receiving extended oral anticoagulant therapy for first unprovoked venous thromboembolism: A systematic review and meta‐analysis

Author

Khan, Faizan, Tritschler, Tobias, Kimpton, Miriam, Wells, Philip S., Kearon, Clive, Weitz, Jeffrey I., Büller, Harry R., Raskob, Gary E., Ageno, Walter, Couturaud, Francis, Prandoni, Paolo, Palareti, Gualtiero, Legnani, Cristina, Kyrle, Paul A., Eichinger, Sabine, Eischer, Lisbeth, Becattini, Cecilia, Agnelli, Giancarlo, Vedovati, Maria Cristina, Geersing, Geert‐Jan, Takada, Toshihiko, Cosmi, Benilde, Aujesky, Drahomir, Marconi, Letizia, Palla, Antonio, Siragusa, Sergio, Bradbury, Charlotte A., Parpia, Sameer, Mallick, Ranjeeta, Lensing, Anthonie W.A., Gebel, Martin, Grosso, Michael A., Shi, Minggao, Thavorn, Kednapa, Hutton, Brian, Le Gal, Gregoire, Rodger, Marc, and Fergusson, Dean

Published
2021
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14. Heavy menstrual bleeding on direct factor Xa inhibitors: Rationale and design of the MEDEA study

Author

Hamulyák, Eva N., Wiegers, Hanke M.G., Scheres, Luuk J.J., Hutten, Barbara A., de Lange, Maria E., Timmermans, Anne, Westerweel, Peter E., Nijziel, Marten R., Kruip, Marieke J.H.A., ten Wolde, Marije, Ypma, Paula F., Klok, Frederikus A., Nieuwenhuizen, Laurens, van Wissen, Sanne, Hovens, Marcel M.C., Faber, Laura M., Kamphuisen, Pieter W., Büller, Harry R., and Middeldorp, Saskia

Published
2021
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17. Evaluating prophylactic heparin in ambulatory patients with solid tumours: a systematic review and individual participant data meta-analysis

Author

Schünemann, Holger J, Ventresca, Matthew, Crowther, Mark, Briel, Matthias, Zhou, Qi, Noble, Simon, Macbeth, Fergus, Griffiths, Gareth, Garcia, David, Lyman, Gary H, Di Nisio, Marcello, Iorio, Alfonso, Mbuagbaw, Lawrence, Neumann, Ignacio, van Es, Nick, Brouwers, Melissa, Guyatt, Gordon, Streiff, Michael B, Marcucci, Maura, Baldeh, Tejan, Florez, Ivan D, Alma, Ozlem Gurunlu, Solh, Ziad, Bossuyt, Patrick M, Kahale, Lara A, Ageno, Walter, Bozas, George, Büller, Harry R, Lebeau, Bernard, Lecumberri, Ramon, Loprinzi, Charles, McBane, Robert, Sideras, Kostandinos, Maraveyas, Anthony, Pelzer, Uwe, Perry, James, Klerk, Clara, Agnelli, Giancarlo, and Akl, Elie A

Published
2020
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19. The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta‐analysis

Author

van Es, Nick, Ventresca, Matthew, Di Nisio, Marcello, Zhou, Qi, Noble, Simon, Crowther, Mark, Briel, Matthias, Garcia, David, Lyman, Gary H., Macbeth, Fergus, Griffiths, Gareth, Iorio, Alfonso, Mbuagbaw, Lawrence, Neumann, Ignacio, Brozek, Jan, Guyatt, Gordon, Streiff, Michael B., Baldeh, Tejan, Florez, Ivan D., Gurunlu Alma, Ozlem, Agnelli, Giancarlo, Ageno, Walter, Marcucci, Maura, Bozas, George, Zulian, Gilbert, Maraveyas, Anthony, Lebeau, Bernard, Lecumberri, Ramon, Sideras, Kostandinos, Loprinzi, Charles, McBane, Robert, Pelzer, Uwe, Riess, Hanno, Solh, Ziad, Perry, James, Kahale, Lara A., Bossuyt, Patrick M., Klerk, Clara, Büller, Harry R., Akl, Elie A., and Schünemann, Holger J.

Published
2020
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21. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event : systematic review and meta-analysis

Author

MARVELOUS Collaborators, Khan, Faizan, Rahman, Alvi, Carrier, Marc, Kearon, Clive, Weitz, Jeffrey I, Schulman, Sam, Couturaud, Francis, Eichinger, Sabine, Kyrle, Paul A, Becattini, Cecilia, Agnelli, Giancarlo, Brighton, Timothy A, Lensing, Anthonie W A, Prins, Martin H, Sabri, Elham, Hutton, Brian, Pinede, Laurent, Cushman, Mary, Palareti, Gualtiero, Wells, George A, Prandoni, Paolo, Büller, Harry R, and Rodger, Marc A

Published
2019

23. Ruling out pulmonary embolism across different healthcare settings: A systematic review and individual patient data meta-analysis

Author

Geersing, Geert-Jan, Takada, Toshihiko, Klok, Frederikus A., Büller, Harry R., Courtney, D. Mark, Freund, Yonathan, Galipienzo, Javier, Le Gal, Gregoire, Ghanima, Waleed, Kline, Jeffrey A., Huisman, Menno V., Moons, Karel G. M., Perrier, Arnaud, Parpia, Sameer, Robert-Ebadi, Helia, Righini, Marc, Roy, Pierre-Marie, van Smeden, Maarten, Stals, Milou A. M., Wells, Philip S., de Wit, Kerstin, Kraaijpoel, Noémie, and van Es, Nick

Subjects
Pulmonary embolism -- Diagnosis, Diagnosis -- Comparative analysis -- Evaluation, Biological sciences
Abstract

Background The challenging clinical dilemma of detecting pulmonary embolism (PE) in suspected patients is encountered in a variety of healthcare settings. We hypothesized that the optimal diagnostic approach to detect these patients in terms of safety and efficiency depends on underlying PE prevalence, case mix, and physician experience, overall reflected by the type of setting where patients are initially assessed. The objective of this study was to assess the capability of ruling out PE by available diagnostic strategies across all possible settings. Methods and findings We performed a literature search (MEDLINE) followed by an individual patient data (IPD) meta-analysis (MA; 23 studies), including patients from self-referral emergency care (n = 12,612), primary healthcare clinics (n = 3,174), referred secondary care (n = 17,052), and hospitalized or nursing home patients (n = 2,410). Multilevel logistic regression was performed to evaluate diagnostic performance of the Wells and revised Geneva rules, both using fixed and adapted D-dimer thresholds to age or pretest probability (PTP), for the YEARS algorithm and for the Pulmonary Embolism Rule-out Criteria (PERC). All strategies were tested separately in each healthcare setting. Following studies done in this field, the primary diagnostic metrices estimated from the models were the 'failure rate' of each strategy-i.e., the proportion of missed PE among patients categorized as 'PE excluded' and 'efficiency'-defined as the proportion of patients categorized as 'PE excluded' among all patients. In self-referral emergency care, the PERC algorithm excludes PE in 21% of suspected patients at a failure rate of 1.12% (95% confidence interval [CI] 0.74 to 1.70), whereas this increases to 6.01% (4.09 to 8.75) in referred patients to secondary care at an efficiency of 10%. In patients from primary healthcare and those referred to secondary care, strategies adjusting D-dimer to PTP are the most efficient (range: 43% to 62%) at a failure rate ranging between 0.25% and 3.06%, with higher failure rates observed in patients referred to secondary care. For this latter setting, strategies adjusting D-dimer to age are associated with a lower failure rate ranging between 0.65% and 0.81%, yet are also less efficient (range: 33% and 35%). For all strategies, failure rates are highest in hospitalized or nursing home patients, ranging between 1.68% and 5.13%, at an efficiency ranging between 15% and 30%. The main limitation of the primary analyses was that the diagnostic performance of each strategy was compared in different sets of studies since the availability of items used in each diagnostic strategy differed across included studies; however, sensitivity analyses suggested that the findings were robust. Conclusions The capability of safely and efficiently ruling out PE of available diagnostic strategies differs for different healthcare settings. The findings of this IPD MA help in determining the optimum diagnostic strategies for ruling out PE per healthcare setting, balancing the trade-off between failure rate and efficiency of each strategy., Author(s): Geert-Jan Geersing 1,*, Toshihiko Takada 1,2, Frederikus A. Klok 3, Harry R. Büller 4, D. Mark Courtney 5, Yonathan Freund 6, Javier Galipienzo 7, Gregoire Le Gal 8, Waleed [...]

Published
2022
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25. Novel insights into weight loss: acupuncture combined with a very low-carbohydrate diet—a Swiss experience.

Author

Fumagalli, Massimo, Landgraaf, Raymond G, Schiavi-Lods, Nadège N, Golcea, Sorin S, Büller, Harry R, and Nieuwdorp, Max

Subjects
OBESITY treatment, DIET in disease, EVALUATION of human services programs, ANALYSIS of variance, ACUPUNCTURE, LOW-carbohydrate diet, RETROSPECTIVE studies, DIET therapy, TREATMENT effectiveness, T-test (Statistics), WEIGHT loss, DESCRIPTIVE statistics, SWISS, BODY mass index
Abstract

Objective: The objective of this study was to assess the effects of an acupuncture–diet program for treatment of overweight and obesity. Methods: The program consisted of weekly acupuncture sessions combined with a very low-carbohydrate diet in patients with a body mass index (BMI) of 25 kg/m2 or above. Data were collected retrospectively between 2002 and 2021 in seven clinics in Switzerland through automated data extraction of existing medical records. The treatments described are standard care at the facilities where they took place. Results: A total of 11,233 patients were included. In those with a BMI of 25 kg/m2 or above, a positive effect on body weight was noted with a peak average body weight loss of approximately 17.5 kg reached after 7 months. Long-term stabilization was at about 15.5 kg after 18 months. Significant male–female differences (p < 0.01) were observed with women losing less weight. Differences were also noted between overweight, obese and extremely obese patients suggesting a BMI-dependent effect. Maximum weight loss of patients with BMI of 35 kg/m2 or above was 29.8 ± 12 kg, while it was 18.8 ± 8 kg for obese patients (BMI = 30–34.9 kg/m2) and 12 ± 7 kg for overweight patients (BMI = 25–29.9 kg/m2), reflecting a significant overall difference between groups (p < 0.01). Compliance to the protocol by patients and physicians seemed to be another differentiating factor; more adherent patients appeared to lose more weight and preserve body weight loss better over time. Conclusion: Although this study lacked a control group and was retrospective and observational in nature, a program of acupuncture combined with a very low-carbohydrate diet appeared to be effective at inducing weight loss among obese patients. The observed weight reduction in this retrospective chart review represents a good starting point for further investigation of this approach via a comparative evaluation. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism

Author

Raskob, Gary E., van Es, Nick, Verhamme, Peter, Carrier, Marc, Di Nisio, Marcello, Garcia, David, Grosso, Michael A., Kakkar, Ajay K., Kovacs, Michael J., Mercuri, Michele F., Meyer, Guy, Segers, Annelise, Shi, Minggao, Wang, Tzu-Fei, Yeo, Erik, Zhang, George, Zwicker, Jeffrey I., Weitz, Jeffrey I., and Büller, Harry R.

Published
2018
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33. Diagnostic management of acute pulmonary embolism: a prediction model based on a patient data meta-analysis.

Author

Es, Nick van, Takada, Toshihiko, Kraaijpoel, Noémie, Klok, Frederikus A, Stals, Milou A M, Büller, Harry R, Courtney, D Mark, Freund, Yonathan, Galipienzo, Javier, Gal, Grégoire Le, Ghanima, Waleed, Huisman, Menno V, Kline, Jeffrey A, Moons, Karel G M, Parpia, Sameer, Perrier, Arnaud, Righini, Marc, Robert-Ebadi, Helia, Roy, Pierre-Marie, and Wells, Phil S

Subjects
PULMONARY embolism, CLINICAL prediction rules, NURSING home residents, PREDICTION models, VENOUS thrombosis, THROMBOEMBOLISM, SYMPTOMS
Abstract

Aims Risk stratification is used for decisions regarding need for imaging in patients with clinically suspected acute pulmonary embolism (PE). The aim was to develop a clinical prediction model that provides an individualized, accurate probability estimate for the presence of acute PE in patients with suspected disease based on readily available clinical items and D-dimer concentrations. Methods and results An individual patient data meta-analysis was performed based on sixteen cross-sectional or prospective studies with data from 28 305 adult patients with clinically suspected PE from various clinical settings, including primary care, emergency care, hospitalized and nursing home patients. A multilevel logistic regression model was built and validated including ten a priori defined objective candidate predictors to predict objectively confirmed PE at baseline or venous thromboembolism (VTE) during follow-up of 30 to 90 days. Multiple imputation was used for missing data. Backward elimination was performed with a P -value <0.10. Discrimination (c-statistic with 95% confidence intervals [CI] and prediction intervals [PI]) and calibration (outcome:expected [O:E] ratio and calibration plot) were evaluated based on internal-external cross-validation. The accuracy of the model was subsequently compared with algorithms based on the Wells score and D-dimer testing. The final model included age (in years), sex, previous VTE, recent surgery or immobilization, haemoptysis, cancer, clinical signs of deep vein thrombosis, inpatient status, D-dimer (in µg/L), and an interaction term between age and D-dimer. The pooled c-statistic was 0.87 (95% CI, 0.85–0.89; 95% PI, 0.77–0.93) and overall calibration was very good (pooled O:E ratio, 0.99; 95% CI, 0.87–1.14; 95% PI, 0.55–1.79). The model slightly overestimated VTE probability in the lower range of estimated probabilities. Discrimination of the current model in the validation data sets was better than that of the Wells score combined with a D-dimer threshold based on age (c-statistic 0.73; 95% CI, 0.70–0.75) or structured clinical pretest probability (c-statistic 0.79; 95% CI, 0.76–0.81). Conclusion The present model provides an absolute, individualized probability of PE presence in a broad population of patients with suspected PE, with very good discrimination and calibration. Its clinical utility needs to be evaluated in a prospective management or impact study. Registration PROSPERO ID 89366. [ABSTRACT FROM AUTHOR]

Published
2023
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34. Treatment of Cancer-Associated Thrombosis: Recent Advances, Unmet Needs, and Future Direction.

Author

Wang, Tzu-Fei, Khorana, Alok A, Agnelli, Giancarlo, Bloomfield, Dan, Bonaca, Marc P, Büller, Harry R, Connors, Jean M, Goto, Shinya, Jing, Zhi-Cheng, Kakkar, Ajay K, Khder, Yasser, Raskob, Gary E, Soff, Gerald A, Verhamme, Peter, Weitz, Jeffrey I, and Carrier, Marc

Subjects
THROMBOEMBOLISM risk factors, ENOXAPARIN, EVALUATION of medical care, DRUG efficacy, VEINS, ANTICOAGULANTS, HEMOSTASIS, THROMBOEMBOLISM, LOW-molecular-weight heparin, DRUG interactions, TUMORS, MEDICAL needs assessment, PATIENT safety, DISEASE complications
Abstract

Cancer-associated thrombosis, with the incidence rising over the years, is associated with significant morbidity and mortality in patients with cancer. Recent advances in the treatment of cancer-associated venous thromboembolism (VTE) include the introduction of direct oral anticoagulants (DOACs), which provide a more convenient and effective option than low-molecular-weight heparin (LMWH). Nonetheless, important unmet needs remain including an increased risk of bleeding in certain patient subgroups such as those with gastroesophageal cancer, concerns about drug-drug interactions, and management of patients with severe renal impairment. Although DOACs are more convenient than LMWH, persistence can decline over time. Factor XI inhibitors have potential safety advantages over DOACs because factor XI appears to be essential for thrombosis but not hemostasis. In phase II trials, some factor XI inhibitors were superior to enoxaparin for the prevention of VTE after knee replacement surgery without increasing the risk of bleeding. Ongoing trials are assessing the efficacy and safety of factor XI inhibitors for the treatment of cancer-associated VTE. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score.

Author

Winter, Maria A de, Büller, Harry R, Carrier, Marc, Cohen, Alexander T, Hansen, John-Bjarne, Kaasjager, Karin A H, Kakkar, Ajay K, Middeldorp, Saskia, Raskob, Gary E, Sørensen, Henrik T, Visseren, Frank L J, Wells, Philip S, Dorresteijn, Jannick A N, Nijkeuter, Mathilde, and group, VTE-PREDICT study

Subjects
DISEASE risk factors, THROMBOEMBOLISM, DISEASE relapse, HEMORRHAGE, ANTICOAGULANTS
Abstract

Aims Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence and bleeding in patients with VTE without cancer who completed at least 3 months of initial treatment, which can be used to estimate individual absolute benefits and harms of extended anticoagulation. Methods and results Competing risk-adjusted models were derived to predict recurrent VTE and clinically relevant bleeding (non-major and major) using 14 readily available patient characteristics. The models were derived from combined individual patient data from the Bleeding Risk Study, Hokusai-VTE, PREFER-VTE, RE-MEDY, and RE-SONATE (n = 15,141, 220 recurrences, 189 bleeding events). External validity was assessed in the Danish VTE cohort, EINSTEIN-CHOICE, GARFIELD-VTE, MEGA, and Tromsø studies (n = 59 257, 2283 recurrences, 3335 bleeding events). Absolute treatment effects were estimated by combining the models with hazard ratios from trials and meta-analyses. External validation in different settings showed agreement between predicted and observed risks up to 5 years, with C-statistics ranging from 0.48–0.71 (recurrence) and 0.61–0.68 (bleeding). In the Danish VTE cohort, 5-year risks ranged from 4% to 19% for recurrent VTE and 1% –19% for bleeding. Conclusion The VTE-PREDICT risk score can be applied to estimate the effect of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Long-term Risk of Recurrent Venous Thromboembolism Among Patients Receiving Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism

Author

Khan, Faizan, Tritschler, Tobias, Kimpton, Miriam, Wells, Philip S, Kearon, Clive, Weitz, Jeffrey I, Büller, Harry R, Raskob, Gary E, Ageno, Walter, Couturaud, Francis, Prandoni, Paolo, Palareti, Gualtiero, Legnani, Cristina, Kyrle, Paul A, Eichinger, Sabine, Eischer, Lisbeth, Becattini, Cecilia, Agnelli, Giancarlo, Vedovati, Maria Cristina, Geersing, Geert-Jan, Takada, Toshihiko, Cosmi, Benilde, Aujesky, Drahomir, Marconi, Letizia, Palla, Antonio, Siragusa, Sergio, Bradbury, Charlotte A, Parpia, Sameer, Mallick, Ranjeeta, Lensing, Anthonie W A, Gebel, Martin, Grosso, Michael A, Shi, Minggao, Thavorn, Kednapa, Hutton, Brian, Le Gal, Gregoire, Rodger, Marc, and Fergusson, Dean

Subjects
cardiovascular diseases, equipment and supplies
Abstract

BACKGROUND The long-term risk for recurrent venous thromboembolism (VTE) during extended anticoagulation for a first unprovoked VTE is uncertain. OBJECTIVES To determine the incidence of recurrent VTE during extended anticoagulation up to 5 years in patients with a first unprovoked VTE. METHODS MEDLINE, EMBASE, and the Cochrane CENTRAL were searched to identify randomized trials and prospective cohort studies reporting recurrent VTE among patients with a first unprovoked VTE who were to receive anticoagulation for a minimum of 6 additional months after completing ≥ 3 months of initial treatment. Unpublished data on number of recurrent VTE and person-years, obtained from authors of included studies, were used to calculate study-level incidence rate, and random-effects meta-analysis was used to pool results. RESULTS Twenty-six studies and 15, 603 patients were included in the analysis. During 11, 631 person-years of follow-up, the incidence of recurrent VTE and fatal pulmonary embolism per 100 person-years was 1.41 (95% CI, 1.03-1.84) and 0.09 (0.04-0.16), with 5-year cumulative incidences of 7.1% (3.0%-13.2%) and 1.2% (0.4%-4.6%), respectively. The incidence of recurrent VTE was 1.08 (95% CI, 0.77-1.44) with direct oral anticoagulants and 1.55 (1.01-2.20) with vitamin K antagonists. The case-fatality rate of recurrent VTE was 4.9% (95% CI, 2.2%-8.7%). CONCLUSIONS In patients with a first unprovoked VTE, the long-term risk of recurrent VTE during extended anticoagulation is low but not negligible. Thus, clinicians and patients should be aware of this risk and take appropriate and timely action in case of suspicion of recurrent VTE. Estimates from this study can be used to advise patients on what to expect while receiving extended anticoagulation, and estimate the net clinical benefit of extended treatment to guide long-term management of unprovoked VTE.

Published
2021

49. Treatment and long-term clinical outcomes of incidental pulmonary embolism in patients with cancer: An international prospective cohort study

Author

Kraaijpoel, Noémie, Bleker, Suzanne M., Meyer, Guy, Mahé, Isabelle, Muñoz, Andrés, Bertoletti, Laurent, Bartels-Rutten, Annemarieke, Beyer-Westendorf, Jan, Porreca, Ettore, Boulon, Carine, van Es, Nick, Iosub, Diana I., Couturaud, Francis, Biosca, Mercedes, Lerede, Teresa, Lacroix, Philippe, Maraveyas, Anthony, Aggarwal, Anita, Girard, Philippe, Büller, Harry R., di Nisio, Marcello, Accassat, S., Aquilant, S., Assaf, J. D., Baars, J., Beenen, L. M., Bergmann, J. F., Bozas, G., Caliandro, R., Carrier, M., Confrere, E., Constans, J., Désormais, I., Dublanchet, N., Endig, S., Falanga, A., Falvo, N., Ferrer Pérez, Al, García Escobar, I., Gonzàlez Santiago, S., Grange, C., Helfer, H., Kleinjan, A., Lalezari, F., de Magalhaes, E., Marten, S., Martinez del Prado, P., Otten, H. M., Paleiron, N., Pérez Ramírez, S., ACS - Pulmonary hypertension & thrombosis, Vascular Medicine, and ARD - Amsterdam Reproduction and Development

Subjects
Cancer Research, medicine.medical_specialty, business.industry, Incidence (epidemiology), Cancer, 030204 cardiovascular system & hematology, medicine.disease, Pulmonary embolism, 03 medical and health sciences, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, Internal medicine, medicine, Cumulative incidence, Clinical significance, Lung cancer, Prospective cohort study, business, Cohort study
Abstract

PURPOSE Pulmonary embolism is incidentally diagnosed in up to 5% of patients with cancer on routine imaging scans. The clinical relevance and optimal therapy for incidental pulmonary embolism, particularly distal clots, is unclear. The aim of the current study was to assess current treatment strategies and the long-term clinical outcomes of incidentally detected pulmonary embolism in patients with cancer. PATIENTS AND METHODS We conducted an international, prospective, observational cohort study between October 22, 2012, and December 31, 2017. Unselected adults with active cancer and a recent diagnosis of incidental pulmonary embolism were eligible. Outcomes were recurrent venous thromboembolism, major bleeding, and all-cause mortality during 12 months of follow-up. Outcome events were centrally adjudicated. RESULTS A total of 695 patients were included. Mean age was 66 years and 58% of patients were male. 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 venous thromboembolism occurred in 41 patients (12-month cumulative incidence, 6.0%; 95% CI, 4.4% to 8.1%), major bleeding in 39 patients (12-month cumulative incidence, 5.7%; 95% CI, 4.1% to 7.7%), and 283 patients died (12-month cumulative incidence, 43%; 95% CI, 39% to 46%). The 12-month incidence of recurrent venous thromboembolism was 6.4% in those with subsegmental pulmonary embolism compared with 6.0% in those with more proximal pulmonary embolism (subdistribution hazard ratio, 1.1; 95% CI, 0.37 to 2.9; P = .93). CONCLUSION In patients with cancer with incidental pulmonary embolism, risk of recurrent venous thromboembolism is significant despite anticoagulant treatment. Patients with subsegmental pulmonary embolism seemed to have a risk of recurrent venous thromboembolism comparable to that of patients with more proximal clots.

Published
2019

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