IPE is defined as a PE detected on a CT scan (not a pulmonary angiogram) done for reasons other than suspected PE. This study is to evaluate the incidence of IPE in oncology patients with current macroscopic disease, and the outcome that could potentially be affected by a delay in starting anticoagulation therapy due to delayed reporting of these routine (non-urgent) scans.
CT thorax with iv contrast done on oncology patients between 01.01.15 – 31.12.15 in two district general hospitals in a cancer network were identified from the database. The scan reports and clinic letters were reviewed for data on cancer diagnosis, macroscopic disease, PE, treatments and survivals.
2147 scans were identified. 543 scans were excluded due to absence of macroscopic disease (No IPE was reported in any of these scans.) leaving 1604 scans eligible for this study. Incidence for different tumour is shown in the table 1. 26 IPE patients are female = 15; median age = 66 (range 32 – 90); main artery = 9; lobar artery = 5; average time from CT scan to anticoagulation (LMWH) therapy is 9.7 days (median = 5 days; range = 0 – 61 days; no treatment in 3 patients) mainly due to the delay in reporting (median = 1 day; range = 0 – 60 days). The median survival from the scan date is 7 months (range = 1 – 22) with 9 patients still alive and 2 lost to follow up. None of the patients whose anticoagulation started 5 or more days after the CT scan died within 3 months. IPE was absent in all subsequent CT scans. This happened without any anticoagulation therapy in one patient who had a segmental IPE. Table 1. Incidence of IPE for different tumour typesrnTable:
|Patients||Scans||Scans with IPE (% of total scans)rn|
|H & Nrn||8rn||18rn||0rn|
Incidence of IPE in oncology patients with current macroscopic disease is low (1.6%) in daily practice. Most patients are likely to have lung, breast and colorectal cancers. This is probably due to the fact that these are common tumours, and the frequency of scanning in their management. No sudden death or mortality within 30 days was noted among patients who had anticoagulation therapy started 5 or more days after the CT scan. Spontaneous resolution of PE happened in one patient with segmental PE. More research is needed to select patients who may not get any meaningful benefit from anticoagulation in the presence of advanced malignant disease.
Clinical trial identification
Legal entity responsible for the study
Maung Maung Myat Moe
All authors have declared no conflicts of interest.