Acute pulmonary embolism and cancer: findings from the COPE study

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: (Figure presented.)