The anticoagulant treatment dilemma in pulmonary embolism associated to cancer

Pulmonary embolism (PE) is defined by the obstruction of pulmonary arteries by thrombi or emboli (malignant, grease, air). Most frequently, thrombi arise from deep veins of lower limbs. Pulmonary embolism is a medical emergency with a high death risk. Early mortality is high, sudden death occurs in about a quarter of the patients. On long term, it can lead to post-embolic pulmonary hypertension and recurrent pulmonary embolia. The high risk of death in acute phase and on long-term depends on the severity of the acute phase, on the recurrence, and on the co-morbidities. PE can be the first manifestation of on occult malignancy, or it may complicate an already diagnosed cancer.

We present a retrospective analysis on PE associated to malignancy, on 106 patients, with classic anticoagulant treatment (low weight molecule heparin and/or antivitamin K agents) or novel oral anticoagulants (NOAC) and compare the early and late mortality associated to PE and anticoagulant treatment. Our observations note a higher percentage of recurrences but significantly lower mortality in patients treated with NOAC as compared to classic treatments.