Review Supports LMWH for Cancer-Linked Incidental PE
(HealthDay News) — Cancer-associated incidental pulmonary embolism (IPE) should be treated with low molecular weight heparins (LMWHs), according to a review published online Oct. 15 in the Journal of Thrombosis and Haemostasis.
Tom van der Hulle, MD, from Leiden University Medical Center in the Netherlands, and colleagues conducted a systematic literature review on cancer-associated IPE management. They pooled data on incidence rates of symptomatic recurrent VTE, major hemorrhage, and mortality during a six-month follow-up of 926 cancer patients with IPE from 11 cohorts.
The researchers found that the weighted pooled six-month risks were 5.8, 4.7, and 37% for recurrent VTE, major hemorrhage, and mortality, respectively. The risk of VTE recurrence was comparable under LMWHs and vitamin-K antagonists (VKAs) (6.2 vs. 6.4%; hazard ratio [HR], 0.9; 95% confidence interval [CI], 0.3–3.1), compared with 12% in untreated patients (HR, 2.6; 95% CI, 0.91–7.3). Major hemorrhage risk was higher under VKA than LMWH (13 vs. 3.9%; HR, 3.9; 95% CI, 1.6–10). In patients with subsegmental IPE and those with a more proximally localized IPE, the VTE recurrence risk was comparable (HR, 1.1; 95% CI, 0.50–2.4).
"These results support the current recommendation to anticoagulate cancer-associated IPE with LMWH and argue against different management of subsegmental IPE," the authors write.