Abstract 17285: Trends and Outcomes of Fibrinolytic Therapy in Patients With Pulmonary Embolism and Metastatic Cancer
Introduction: Pulmonary embolism in the setting of cancer portends a poor prognosis. There is limited data on the use and outcomes of fibrinolytic therapy (FT) in this subgroup of patients. This study describes temporal trends and outcomes of the use of FT among these patients. Hypothesis: The use of FT in patients with metastatic cancer and acute pulmonary embolism is associated with higher mortality Methods: Using the NIS database, we extracted patients with metastatic cancer admitted with a primary diagnosis of acute pulmonary embolism from January 2010 to December 2014. Using weighted data we analyzed the trends of FT in these patients. For analysis of outcomes, we performed a propensity score matching (match tolerance.01) of patients with PE and FT. After matching, we compared baseline characteristics and inpatient outcomes of patients with PE who underwent FT with those that did not. Or primary outcome was mortality. We performed a multivariable regression analysis with mortality as our outcome. We also described predictors of mortality in patients that underwent FT. Results: Of the 65,882 patients with metastatic cancer admitted with a primary diagnosis of PE, 946 (1.4%) underwent fibrinolytic therapy. There was a significant trends of increase in the use of FT in this cohort of patients, increasing from 0.9% in 2010 to 2.1% in 2014. After exclusions 666 were included in the propensity match and all were matched. Both groups were well matched with regards to baseline characteristics. Patients with FT were less likely to be Caucasian or have anemia. The use of FT was more common in teaching hospitals. Patients in the FT arm were more likely to have cardiac arrest, respiratory failure and acute renal failure. There was no difference in rates of bleeding or blood transfusion. Mortality was significantly higher in the FT arm (24% vs. 1.6%, p<.01). In multivariable analysis, FT was independently associated with mortality (OR 8.35, 95% CI 2.2-32.94; p<.01). Among patients with metastatic cancer and acute PE that underwent FT, independent predictors of mortality were Obesity (OR 4.51, 95% CI 1.35-15.03; p=.02), history of coagulopathy (OR 6.71, 95% CI 1.35-33.46; p=.02), current tobacco abuse (OR 3.26, 95% CI 1.04-10.21; p=.04) and a history of anticoagulant use (OR 2.21, 95% CI 1.02-4.82; p=.046). Conclusions: Fibrinolytic therapy in patients with metastatic cancer and acute pulmonary embolism is associated with increase mortality. The clinical benefits expected from the use fibrinolytic therapy in these patients should be weighed against the risks.