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Open Access 15-11-2023 | Direct Oral Anticoagulant | Original Paper

Acute pulmonary embolism and cancer: findings from the COPE study

Authors: Cecilia Becattini, Ludovica Anna Cimini, Giorgio Bassanelli, Aldo P. Maggioni, Fulvio Pomero, Ilaria Lobascio, Iolanda Enea, Daniela P. Pomata, Maria Pia Ruggieri, Beniamino Zalunardo, Anna Novelli, Stefania Angela Di Fusco, Marco Triggiani, Marco Marzolo, Chiara Fioravanti, Giancarlo Agnelli, Lucio Gonzini, Michele M. Gulizia, on behalf of COPE Investigators

Published in: Clinical Research in Cardiology | Issue 2/2024

Abstract

Background

Patients with acute venous thromboembolism associated with cancer have an increased risk of recurrences and bleeding in the long term.

Research question

To describe the clinical features and short-term course of patients with acute pulmonary embolism (PE) and active cancer, previous cancer or no cancer.

Study design and methods

Patients with acute PE included in COPE—prospective, multicentre study of adult patients with acute, symptomatic, objectively diagnosed PE—were classified as having active cancer, previous cancer, or no cancer.

Results

Overall, 832 patients had active cancer, 464 with previous cancer and 3660 patients had no cancer at the time of acute PE. The most prevalent primary sites of active cancer were urogenital (23.0%), gastrointestinal (21.0%), and lung (19.8%), with a high prevalence of metastatic disease (57.6%) and ongoing anticancer treatment (16.2%). At discharge, a direct oral anticoagulant was used in 43.1%, 78.8%, and 82.0% of patients with active cancer, previous cancer, and no cancer, respectively. Rates of death in-hospital and at 30 days were higher in patients with active cancer compared to patients with previous cancer and no cancer (7.9% vs. 4.3% vs. 2.2% and 13.8% vs. 5.2% vs. 2.6%, respectively). Rates of major bleeding were 4.8%, 2.6%, and 2.4%, respectively. Among patients with active cancer, lung or metastatic cancer were independent predictors of death; brain, hematological or gastrointestinal cancer had the highest risk of major bleeding.

Interpretation

Among patients with acute PE, those with active cancer have high risks for death or major bleeding within 30 days. These risks vary based on primary site of cancer.

Clinical trial registration: clinicaltrial.gov identifier: NCT03631810.

Graphical abstract

Available only for authorised users

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Title: Acute pulmonary embolism and cancer: findings from the COPE study
Authors: Cecilia Becattini
Ludovica Anna Cimini
Giorgio Bassanelli
Aldo P. Maggioni
Fulvio Pomero
Ilaria Lobascio
Iolanda Enea
Daniela P. Pomata
Maria Pia Ruggieri
Beniamino Zalunardo
Anna Novelli
Stefania Angela Di Fusco
Marco Triggiani
Marco Marzolo
Chiara Fioravanti
Giancarlo Agnelli
Lucio Gonzini
Michele M. Gulizia
on behalf of COPE Investigators
Publication date: 15-11-2023
Publisher: Springer Berlin Heidelberg
Keywords: Direct Oral Anticoagulant
Direct Oral Anticoagulant
Anticoagulant
Acute Pulmonary Embolism
Acute Pulmonary Embolism
Acute Pulmonary Embolism
Published in: Clinical Research in Cardiology / Issue 2/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-023-02323-z

2024 ASCO Annual Meeting

Springer Medicine

Acute pulmonary embolism and cancer: findings from the COPE study

Abstract

Background

Research question

Study design and methods

Results

Interpretation

Graphical abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Research question

Study design and methods

Results

Interpretation

Graphical abstract

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