Regular ArticleLong-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

•627 patients with acute PE, with/without malignancy, were followed for 1 year at least.•The malignant group had less embolic burden compared with the non-malignancy group.•In malignancy patients, the survival time was longer in LMWH group than VKA group.•The mortality in the first 6 months was lower in LMWH group than VKA group.

BackgroundAs 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.MethodsIn 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.ResultsIn 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).ConclusionsPE 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.