The Benefit of an Extensive Cancer Screening Strategy After the First Episode of Unprovoked Pulmonary Embolism

Abstract

Introduction: The etiological assessment after an acute unprovoked pulmonary embolism (PE) represents an essential step in the overall management of the patient, with the aim of adapting the duration and type of anticoagulant to be used, avoiding recurrence and thus improving overall morbidity and mortality, but this is not such a simple question to answer. Purpose: The main objective of this work is to know the benefit of a limited etiology strategy versus an extensive strategy after a first episode of acute non-provoked PE, first on all-cause mortality, and then the superiority of one strategy over another on the diagnosis of cancer at 1 year in patients admitted to a cardiac intensive care unit. Methods: This is a single-center, retrospective study from 2014 to 2021, which includes all patients, admitted to a cardiac intensive care unit for a first episode, at high or high intermediate risk of mortality at day 30. The included patients were divided into 2 groups: those who received a limited cancer screening strategy, and those who received, in addition to the latter, an injected cerebral and cervical-thoracic-abdominal scan, and the determination of tumor markers. All data were extracted from the medical hospital files. Results: In total, we included 130 patients. The mean age of our patients was 87.19 (SD = 6.1), with a female predominance with a percentage of 55.4%. Eighty-seven patients benefited from an extensive cancer screening strategy, versus 43 patients who benefited from a limited strategy. First, for mortality at 1 year, 27 deaths were found between the 2 groups but without significant difference (hazard ratio; 0.53; P = 0.16), and for the mean duration from embolic episode to death, there was a mean of 20 weeks for the limited strategy group and 24 weeks for the extensive strategy group, with a nonsignificant difference (P = 0.106). For the diagnosis of cancer at 1 year, 28 patients were diagnosed with cancer: 13 patients in the limited strategy group versus 15 in the extensive strategy group, with no significant difference (hazard ratio, 1.983; P = 0.082). The mean time to diagnosis was 22 weeks in the limited strategy group and 20 weeks in the extensive strategy, with no significant difference (P = 0.729). Conclusion: To date, no scientific evidence has been established for the extensive versus the limited strategy, therefore, a minimal etiological workup is also effective in the detection of cancer after unprovoked PE.