Clinical features of pulmonary embolism (PE) in cancer patients have not been adequately studied.
OBJECTIVE
To evaluate the course of PE in cancer patients in Russian hospitals using SIRENA register data.
MATERIAL AND METHODS
The data of prospective Russian register of PE (SIRENA) were analyzed. This database enrolls 20 hospitals in 15 cities for 12-month period.
RESULTS
The registry included 660 patients. The group of intravital pulmonary embolism diagnosis included 609 patients (women 50.7%, mean age 63.0±14.5 years, min 19, max 94 years). Malignancies were known in 120 (18.2%) patients. Women, patients with surgery (36.5% vs. 12.0%) or blood transfusion (11.5% vs. 2.5%) in previous year, those with diabetes (42.3% vs. 30.7%), previous implantation of central venous catheter (30.8% vs. 2.9%) prevailed among patients with malignancies compared to those without malignant neoplasms. Asymptomatic PE was significantly more common among patients with malignancies (14.4% vs. 1.5%; relative risk (RR) 9.89; 95% confidence interval (95% CI) 4.14―23.65). In the study group, breast (17%), uterus (14%), stomach (10%), prostate and rectum (8% each) tumors were the most common. Distant metastases were diagnosed in 33.3% of patients with malignant neoplasia. Period between tumor detection and PE was < 6 months in 31.7% of patients, from 6 months to 1 year in 25.0%, over 1 year in 43.3% of patients. At inclusion into the register, 28.3% of patients with malignancies were undergoing antitumor treatment. Thrombolytic drugs (17.3% vs. 27.2%; RR 0.64; 95% CI 0.41—0.99), unfractionated heparin (36.5% vs. 49.4%; RR 0.74; 95% CI 0.56―0.97) and non-vitamin K-associated oral anticoagulants (37.5% vs. 67.4%; RR 0.56; 95% CI 0.43―0.72) were used significantly less frequently in patients with malignancies compared to those without cancer. On the contrary, low molecular weight heparins were more common in these patients (68.3% vs. 56.0%; RR 1.22; 95% CI 1.05―1.42). In-hospital mortality was 11.5% and 9.3%, respectively (RR 1.24; 95% CI 0.68―2.25). In-hospital incidence of bleeding was similar (3.8% vs. 3.9%; RR 0.98; 95% CI 0.34―2.81). Long-term mortality was significantly higher in patients with cancer: after 3 months — 7.6% vs. 0.9% (RR 8.31; 95% CI 2.48―27.81), after 6 months — 10.9% vs. 2.5% (RR 4.32; 1.98―9.88), after 12 months — 12.0% vs. 3.2% (RR 3.73; 95% CI 1.75―7.96).
CONCLUSION
Analysis of Russian register of PE (SIRENA) made it possible to assess the incidence of malignancies in patients with PE (18.2%), to identify the most common localization of tumors (mammary gland, uterus, stomach, prostate gland, rectum). We also determined anamnestic and clinical characteristics of cancer patients, as well as peculiarities of their treatment (thrombolytic therapy, UFH, oral anticoagulants were used less often) and outcomes (in-hospital mortality was similar and long-term period mortality was significantly higher in cancer patients).
