A study recently published in the Journal of Clinical Oncology reported that patients with cancer who are diagnosed with incidental pulmonary embolism (PE) show a substantial risk of developing venous thromboembolism (VTE), even if they have received anticoagulant therapy.

PE affects up to 5% of patients with cancer, but the consequences of an incidental PE in this population have not been fully understood.

Eligibility to enroll in this multicenter, prospective, observational cohort analysis included presence of an active cancer with a recent first diagnosis of an incidental PE. Patients were followed for 12 months, with study outcomes including all-cause mortality, recurrent VTE, and major bleeding events. In total, 695 patients were included.

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Patients had a mean age of 66 years. Nearly all (97%) received anticoagulant therapy, primarily using low-molecular-weight heparin.

At 12 months, the cumulative incidence of all-cause mortality was 43% (95% CI, 39%-46%), with most fatalities attributed to cancer. For major bleeding, the 12-month cumulative incidence was 5.7% (95% CI, 4.1%-7.7%).

Recurrent VTE showed a total 12-month cumulative incidence of 6.0% (95% CI, 4.4%-8.1%), with 78% of these events occurring while patients were still on anticoagulation treatment. For 47% of the patients with recurrent VTE, it was discovered incidentally.

Location of PE (proximal vs subsegmental) did not have a significant association with recurrent VTE (P =.93).

The authors concluded that the risk for recurrent VTE remained high in patients with cancer who had been treated with anticoagulant therapy for an incidental PE. Additionally, the risk for major bleeding did not seem to depend on the dosage of anticoagulation therapy.

“Results of the current study indicate that patients with cancer with incidental PE have a high risk of recurrent VTE despite anticoagulant treatment, which strengthens current guideline advice to treat incidental PE as symptomatic PE for at least 3 to 6 months,” the authors stated in their report.


  1. Kraaijpoel N, Bleker SM, Meyer G, et al. Treatment and long-term clinical outcomes of incidental pulmonary embolism in patients with cancer: an international prospective cohort study [published online May 22, 2019]. J Clin Oncol. doi:10.1200/jco.18.01977