Abstract
BackgroundHome treatment of cancer-associated venous thromboembolism (VTE) is challenging due to the high risk of adverse events. While home treatment is quite agreeable to cancer patients, studies evaluating the safety of VTE home treatment in this setting are largely unavailable. MethodsThis was an observational study in patients with cancer-associated VTE. The main outcomes were the proportion of patients treated at home (hospital discharge <24 h after diagnosis) and the 3-month incidence of VTE-related adverse events (major bleeding, recurrent VTE and/or suspected VTE-related mortality) in patients managed in hospital versus at home. ResultsA total of 183 outpatients were diagnosed with cancer-associated VTE: 69 had deep vein thrombosis (DVT) and 114 had pulmonary embolism (PE ± DVT). Of those, 120 (66%) were treated at home; this was 83% for patients with DVT and 55% for patients with PE (±DVT). The 3-month incidence of any VTE-related adverse event was 13% in those treated at home versus 19% in the hospitalized patients (HR 0.48; 95%CI 0.22–1.1), independent of initial presentation as PE or DVT. All-cause 3-month mortality occurred in 33 patients treated as inpatient (54%) compared to 29 patients treated at home (24%; crude HR 3.1 95%CI 1.9–5.0). ConclusionsTwo-third of patients with cancer-associated VTE - including PE - were selected to start anticoagulant treatment at home. Cancer-associated VTE is associated with high rates of VTE-related adverse events independent of initial in hospital or home treatment. However, home treatment may be a good option for selected patients with cancer-associated DVT or PE.
Highlights
Several large trials have shown that home treatment of selected patients with venous thromboembolism (VTE) is feasible and safe due to a low incidence of adverse events [1,2,3,4,5,6,7,8,9,10,11]
One of the reasons that studies in cancerassociated acute pulmonary embolism (PE) are lacking may be that the current European Society of Cardiology (ESC) algorithm for PE risk stratification - including criteria for home treatment - are based on the simplified PE severity index which categorizes all patients with cancer as ‘high risk’, implicating that those are considered to be ‘nonsuitable’ for home treatment [12]
Patients were eligible for inclusion if they were 18 years or older and had established acute symptomatic or incidental PE involving subsegmental or more proximal pulmonary arteries confirmed by CTPA, or symptomatic or incidental deep vein thrombosis (DVT) of the upper or lower extremities, involving the popliteal, femoral, iliac, subclavian, axillary or brachial vein or the inferior vena cava, diagnosed by compression ultrasound or CT venography [19]
Summary
Several large trials have shown that home treatment of selected patients with venous thromboembolism (VTE) is feasible and safe due to a low incidence of adverse events [1,2,3,4,5,6,7,8,9,10,11]. In these outpatient management studies, only a small minority of patients with cancer-associated VTE were included. Home treatment may be a good option for selected patients with cancer-associated DVT or PE
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