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Outpatient Management of Pulmonary Embolism in Cancer 

Among people with pulmonary embolisms (PE), cancer is associated with adverse outcomes. Also, PEs are fairly common among patients with cancer and are often incidental findings on CT, rather than sudden, symptomatic events. While patients with low-risk PE are often treated on an outpatient basis, there is little evidence for the feasibility of managing cancer patients with low-risk PE in this way. Some of these patients might be good candidates for outpatient treatment.

Dr. Carme Font and colleagues in Spain conducted a prospective cohort study to determine the feasibility of outpatient treatment for patients with cancer and symptomatic vs. incidental PE. They assessed thromboembolism recurrence, major bleeding, and all-cause mortality. The authors also compared the performance of four different prognostic scales in predicting mortality and identifying patients who might be treated at home. These scales have previously been validated to predict short-term PE-related mortality, but not with respect to incidental PE. The study included 138 patients, 62 of whom were managed as outpatients.

The rates of thromboembolism recurrence and major bleeding were similar in both groups of patients, but those treated as outpatients had a lower overall mortality rate at both 30 and 90 days after PE diagnosis. Most of those treated at home also had incidentally detected PE. These results suggest that a large proportion of patients with cancer and PE can be safely treated as outpatients, particularly those with incidental PE. However, at this time, there is no cancer-specific prognostic scale that includes incidental PE for identifying the best candidates and the optimal management of PE in these patients.

For more information, see: Font C, Carmona-Bayonas A, Fernández-Martinez A, Beato C, Vargas A, Gascon P, Otero R. Outpatient management of pulmonary embolism in cancer: data on a prospective cohort of 138 consecutive patients. J Natl Compr Canc Netw. 2014 Mar 1;12(3).