Outpatient management of pulmonary embolism in cancer patients: A matched-cohort analysis.

e21677 Background: Around 30% of cancer patients presenting to the emergency room (ER) with pulmonary embolism (PE) in the Canadian province of Quebec are managed as outpatients (OP). We investigated whether OP management of PE in cancer patients was associated with increased risk of recurrence of venous thromboembolism (VTE) and major bleeding. Methods: Using Quebec healthcare data, we identified all cancer patients with incident PE diagnosed in ER between 2000 and 2009, after excluding high or very-high risk patients, such as patients admitted to intensive care. Outpatient management was defined as the absence of a hospital admission up to 3 days following the ER visit. Outpatients were propensity-score matched 1:1 (0.01 margin) to inpatients (IP) and followed for 90 days for the recurrence of VTE or the occurrence of major bleeding. The hazard ratios (HR) and 95% confidence intervals (CI) of major bleeding and recurrence associated with OP management were assessed with all-cause mortality as a competing risk. Results: In all, 283 OP were matched to 283 IP (Table). By 90 days, 38 recurrences and 10 major bleeding events occurred. Patients with OP management had lower short-term mortality (P = 0.0002, log-rank test). In competing risk analyses, the HR for recurrence at 90 days with OP management was 1.01 (95% CI: 0.52-1.93), and for major bleeding it was 1.00 (95% CI: 0.29-3.45). Conclusions: Outpatient management of cancer patients with low- or intermediate-risk PE was not associated with a higher risk of recurrence or major bleeding, when accounting for the higher risk of death in patients who were admitted to hospital. Baseline characteristics of matched cancer patients with pulmonary embolism. Factor Inpatients, % (n = 283) Outpatients, % (n = 283) Mean age 68.5 69.1 Men 41.3 44.2 Cancer site Breast 18.0 19.1 Lung 22.3 21.6 Colorectal 12.0 13.1 Pancreas 2.1 2.1 Hematologic 8.5 8.5 Genitourinary 26.5 29.3 Other 19.4 17.3 Chemotherapy 19.1 17.3 Radiotherapy 5.7 6.0 History of major bleed 2.1 3.2 Metastases 27.9 26.5 Charlson, median (IQR) 5 (2-8) 6 (3-9) PE risk score < 2 62.5 59.0 2-4 37.5 41.0 ER diagnoses Deep vein thrombosis 14.5 13.4 Acute kidney injury 0.7 0.4 Atrial fibrillation 3.5 3.5 Pneumonia 2.1 2.1 Myocardial infarction 1.4 1.1

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