title: Long-term treatment with low-molecular-weight heparin prolonged the survival time for acute pulmonary embolism patients concurrent with malignancy: an observational analysis from a long-term follow-up study.
abstract: BACKGROUND
  As a special group in pulmonary embolism (PE), the baseline characteristics, better therapeutic strategy and prognosis of patients with concurrent malignancy need to be investigated. Long-term low-molecular-weight heparin (LMWH) is recommended for these patients, however, whether therapeutic strategy affects long-term prognosis remains unclear.
  
  
  METHODS
  In this prospective study, acute symptomatic PE patients confirmed by imaging examinations, with/without malignancy, were enrolled and followed. Qanadli score was used to assess the embolic burden. The clinical endpoints included symptomatic recurrent venous thromboembolism (VTE), all-cause death and clinic relevant bleeding.
  
  
  RESULTS
  In the 627 patients enrolled, 92 patients had malignancy at baseline. The median follow-up period was 36 months. The Qanadli score at baseline was lower in malignancy group than non-malignancy group (P=0.003). 48.9% of patients with malignancy died, while 11.4% of non-malignancy group died (P <0.001). Malignancy was a risk factor of death (HR 5.659, 95%CI 3.090-10.366, P <0.001). In malignancy group, 56 patients used long-term LMWH and 36 patients received oral vitamin K antagonist (VKA). The median survival time was 30 months in LMWH group, significantly longer than 12.5 months in VKA group (P=0.041). The mortality in the first 6 months was lower in LMWH group than VKA group (19.6% vs. 41.7%, P=0.022).
  
  
  CONCLUSIONS
  PE patients with malignancy had much higher incidence of all-cause death in spite of less embolic burden compared with patients without malignancy. Anticoagulation using long-term LMWH could prolong the survival time of PE patients with malignancy, and it was more effective than VKA.
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China. Electronic address: zhaizhenguo2011@126.com.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhai
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China.
authors.forename: Yuanhua
authors.initials: Y
authors.lastname: Yang
authors.affiliation: National Clinical Research Center of Respiratory Medicine, Beijing Hospital, 1 Dahua Rd, Beijing, P.R. China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China.
authors.forename: Juanni
authors.initials: J
authors.lastname: Gong
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China.
authors.forename: Wanmu
authors.initials: W
authors.lastname: Xie
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China.
authors.forename: Tuguang
authors.initials: T
authors.lastname: Kuang
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongti South Rd, Beijing, P.R. China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, 8 Gongti South Rd, Beijing, P.R. China; National Clinical Research Center of Respiratory Medicine, Beijing Hospital, 1 Dahua Rd, Beijing, P.R. China. Electronic address: cyh-birm@263.net.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: Low-molecular-weight heparin; Malignancy; Prognosis; Pulmonary embolism; Venous thromboembolism