• Eric L Ha, Edward M Castillo, Gary M Vilke, Leslie C Oyama, Jesse J Brennan, Paramveer Birring, Shrusti Shah, and Christopher J Coyne.
• UC San Diego School of Medicine, La Jolla, California.
• J Emerg Med. 2021 Sep 1; 61 (3): 241-251.

BackgroundThere is no prior study that has documented emergency department (ED) outcomes or stratified mortality risks of cancer patients presenting with an acute venous thromboembolism (VTE).ObjectiveTo evaluate ED treatment of these patients, to document their outcomes, and to identify risk factors associated with death.MethodsA retrospective cohort study was performed on active cancer patients presenting with deep venous thrombosis or pulmonary embolism to two academic EDs between July 2012 and June 2016. Key outcomes included mortality, ED revisit, and admission within 30 days. The patient cohort was characterized; crosstabs and regression analysis were performed to assess relative risks (RRs) and mitigating factors associated with 30-day mortality.ResultsOf 355 patients, 9% died and 38% had one or more ED revisits or admissions. Recent immobility (RR 2.341, 95% CI 1.227-4.465), poor functional status (RR 2.090, 95% CI 1.028-4.248), recent admission (RR 2.441, 95% CI 1.276-4.669), and metastatic cancer (RR 4.669, 95% CI 1.456-14.979) were major risk factors for mortality. ED-provided anticoagulation reduced the overall mortality risk (RR 0.274, 95% CI 0.146-0.515) and mitigated the risk from recent immobility (RR 1.250, 95% CI 0.462-3.381), especially among patients with good or fair functional status.ConclusionImmobility and cancer morbidity are key risk factors for mortality after an acute VTE, but ED-provided anticoagulation mitigates the risk of immobility among healthier patients. Eastern Cooperative Oncology Group performance status can help clinicians risk stratify these patients at presentation.Copyright © 2021 Elsevier Ltd. All rights reserved.

19 keywords...

hide…