Outpatient management of cancer-associated pulmonary embolism: A post-hoc analysis from the HOME-PE trial.

Introduction: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE.
Methods: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization.
Results: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74).
Conclusions: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Olivier SANCHEZ reports a relationship with Bayer AG that includes: board membership, consulting or advisory, and speaking and lecture fees. Olivier SANCHEZ reports a relationship with Bristol Myers Squibb Co that includes: board membership, consulting or advisory, funding grants, and speaking and lecture fees. Olivier SANCHEZ reports a relationship with Pfizer France that includes: board membership, funding grants, and speaking and lecture fees. Olivier SANCHEZ reports a relationship with Sanofi Aventis France that includes: board membership, consulting or advisory, and speaking and lecture fees. Olivier SANCHEZ reports a relationship with Boston Scientific Corp that includes: board membership. Olivier SANCHEZ reports a relationship with Inari Medical Inc that includes: board membership, funding grants, and speaking and lecture fees. Olivier SANCHEZ reports a relationship with Boehringer Ingelheim Pharmaceuticals Inc that includes: board membership and funding grants. Olivier SANCHEZ reports a relationship with LEO Pharma France that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)