Venous thromboembolism (VTE) is a common complication in patients with cancer. Often, VTEs are incidentally detected on imaging studies undertaken for cancer staging or evaluation of treatment response. Current guidelines recommend that the same anticoagulant treatment be used for both incidental pulmonary embolism (PE) and symptomatic PE in patients with cancer. However, these recommendations are largely based on risk estimates from retrospective data. In this prospective cohort study, 695 patients with active cancer and a recent diagnosis of PE were followed up to assess the long-term clinical outcomes of incidentally detected PE. These outcomes included recurrent VTE, major bleeding, and all-cause mortality during the 12-month follow-up period. At baseline, the mean age of the study population was 66 years, 58% of the patients were male, and 64% had metastatic disease. Colorectal cancer was the most common cancer type (21%), followed by lung cancer (15%) and gynecologic cancers (11%). Anticoagulant therapy was initiated in 97% of patients, and most patients received low-molecular-weight heparins (89%). The median overall treatment duration was 216 days (IQR 136 to 360 days). Researchers found that the cumulative incidence of recurrent VTE was 6.0% (95% CI 4.4% to 8.1%), and 78% of events occurred during the on-treatment period. There was no significant difference in the incidence of recurrent VTE between patients with subsegmental PE and those with proximal PE (6.4% vs. 6.0%, respectively, HR 1.1, 95% CI 0.37 to 2.9, p=0.93). Researchers also found that major bleeding occurred in 5.7% of patients (95% CI 4.1% to 7.7%), and 43% of patients died (95% CI 39% to 46%) during the 12-month follow-up period. Overall, results from this study demonstrate that recurrent VTE is common in patients with cancer who received anticoagulation treatment for incidental PE, and that these patients also have a substantial risk of major bleeding and death.
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