Highlights
- •Acute pulmonary embolism attributable to a neoplasia associates with the worst prognosis.
- •Approximately 80% of patients with acute PE attributable to a neoplasia die within 1-year.
- •Idiopathic PE portends higher death risk than PE secondary to a non-neoplastic condition.
- •Acute idiopathic PE should be looked at as a worrisome clinical entity.
Abstract
Background
Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis
of acute PE in the 21st century has not been fully reported. We aimed to determine
the long-term prognosis of patients hospitalized with acute PE and compare survivalof
patients with idiopathic and secondary PE.
Materials and methods
We retrospectively analysed a cohort of hospitalized patients with acute PE between
2006 and 2013. Exclusion criteria:<18 years, venous embolism of non-pulmonary veins,
chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image
confirmation. Only patients with a first PE episode were included. End-point: all-cause
mortality. Patients were compared according to PE aetiology: idiopathic, secondary
to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression
analysis was used to study the prognostic impact of PE aetiology. RESULTS: We studied
872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was
idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and
secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed
for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to
a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted
HR of mortality of 1.46 (1.08–1.99) during the over 2-year follow-up period when compared
to those with acute PE attributed to a non-neoplastic condition.
Conclusions
Patients with idiopathic acute PE have an almost 50% higher death risk in a median
2-year follow-up period than those with acute PE secondary to a condition other than
neoplasia.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ESC guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J. 2014; 35 (69a-69k): 3033-3069
- Pulmonary embolism and deep vein thrombosis.Lancet. 2012; 379: 1835-1846
- Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.Arch Intern Med. 2011; 171: 831-837
- Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE Study (1985-2009).Am J Med. 2014; 127: 829-39 e5
- Epidemiology, pathophysiology, and natural history of pulmonary embolism.Semin Interv Radiol. 2018; 35: 92-98
- Short- and long-term mortality after pulmonary embolism in patients with and without cancer.Vasc Med. 2018; 23: 261-266
- Natural history of venous thromboembolism.Circ. 2003; 107: I22-I30
- Venous thromboembolism and malignancy.Expert Rev Anticancer Ther. 2004; 4: 303-320
- Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis.Cancer. 2011; 117: 1334-1349
- American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer.J Clin Oncol. 2007; 25: 5490-5505
- Risk factors associated with provoked pulmonary embolism.Korean J Intern Med. 2017; 32: 95-101
- Clinical presentation of acute pulmonary embolism: survey of 800 cases.PLoS One. 2012; 7e30891
- Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry).J Am Coll Cardiol. 2011; 57: 700-706
- Recognition of unprovoked (idiopathic) pulmonary embolism-prospective observational study.Respir Med. 2018; 135: 57-61
- Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.QJM. 2007; 100: 351-359
- Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy.Respir. 2005; 72: 74-78
- Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry.Thromb Res. 2013; 131: 24-30
- Idiopathic (unexplained) pulmonary embolism is associated with an impaired prognosis compared to other entities of pulmonary embolism.Blood Coagul Fibrinolysis. 2010; 21: 70-76
- Clinical guidelines for testing for heritable thrombophilia.Br J Haematol. 2010; 149: 209-220
- Does thrombophilia testing help in the clinical management of patients?.Br J Haematol. 2008; 143: 321-335
- Prevention and treatment of venous thromboembolism--international consensus statement.Int Angiol. 2013; 32: 111-260
- Testing for inherited thrombophilia does not reduce the recurrence of venous thrombosis.J Thromb Haemost. 2008; 6: 1474-1477
- Thrombophilia, clinical factors, and recurrent venous thrombotic events.JAMA. 2005; 293: 2352-2361
- Venous thromboembolism: risk factors for recurrence.Arterioscler Thromb Vasc Biol. 2009; 29: 298-310
- Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.Chest. 2016; 149: 315-352
- Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis.J Thromb Haemost. 2010; 8: 2436-2442
- Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials.BMJ. 2011; 342: d3036
- Six months vs extended Oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE randomized clinical trial.JAMA. 2015; 314: 31-40
- Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism.J Thromb Haemost. 2010; 8: 1926-1932
- An association between atherosclerosis and venous thrombosis.N Engl J Med. 2003; 348: 1435-1441
Article info
Publication history
Published online: July 17, 2019
Accepted:
July 9,
2019
Received in revised form:
July 4,
2019
Received:
April 24,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
