[en] INTRODUCTION: Cancer-related pulmonary embolism (PE) is associated with poor prognosis. Some decision rules identifying patients eligible for home treatment categorize cancer patients at high risk of complications, precluding home treatment. We sought to assess the effectiveness and the safety of outpatient management of patients with low-risk cancer-associated PE. METHODS: In the HOME-PE trial, hemodynamically stable patients with symptomatic PE were randomized to either triaging with Hestia criteria or sPESI score. We analyzed 3 groups of low-risk PE patients: 47 with active cancer treated at home (group 1), 691 without active cancer treated at home (group 2), and 33 with active cancer as the only sPESI criterion qualifying them for hospitalization (group 3). The main outcome was the composite of recurrent venous thromboembolism, major bleeding, and all-cause death within 30 days after randomization. RESULTS: Patients treated at home had composite outcome rates of 4.3 % (2/47) for those with cancer vs. 1.0 % (7/691) for those without (odds ratio (OR) 4.98, 95%CI 1.15-21.49). Patients with cancer had rates of complications of 4.3 % when treated at home vs. 3.0 % (1/33) when hospitalized (OR 1.19, 95%CI 0.15-9.47). In multivariable analysis, active cancer was associated with an increased risk of complications for patients treated at home (OR 7.95; 95%CI 1.48-42.82). For patients with active cancer, home treatment was not associated with the primary outcome (OR 1.19, 95%CI 0.15-9.74). CONCLUSIONS: Among patients treated at home, active cancer was a risk factor for complications, but among patients with active cancer, home treatment was not associated with adverse outcomes.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Chaibi, Sérine; Université Paris Cité, Paris, France, Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France.
Roy, Pierre-Marie; Emergency Department, CHU Angers, Angers F-49000, France, Univ. Angers, INSERM, CNRS, MITOVASC, Equipe CARME, SFR ICAT, Angers, France, F-CRIN, INNOVTE, Saint-Etienne, France.
Guénégou, Armelle Arnoux; Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, Clinical research unit, Clinical Investigation Center 1418 Clinical Epidemiology, INSERM, INRIA, HeKA, Paris, France.
Tran, Yohann; Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, Clinical research unit, Clinical Investigation Center 1418 Clinical Epidemiology, INSERM, Paris, France.
Hugli, Olivier; Emergency Department, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland.
Couturaud, Francis; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France, INSERM U1304-GETBO, CIC-INSERM1412, Univ-Brest, F20609 Brest, France.
Tromeur, Cécile; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Internal Medicine and Chest Disease, CHU Brest, Brest, France, INSERM U1304-GETBO, CIC-INSERM1412, Univ-Brest, F20609 Brest, France.
Szwebel, Tali-Anne; Department of Internal Medicine, Cochin Hospital, APHP, Paris, France.
Pernod, Gilles; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France, University Grenoble Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France.
Elias, Antoine; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Cardiology and Vascular Medicine, Sainte Musse Hospital, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Toulon, France.
Ghuysen, Alexandre ; Université de Liège - ULiège > Département des sciences de la santé publique > Simulation médicale en situation critique
Benhamou, Ygal; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Internal Medicine, CHU Charles Nicolle, Rouen, France, Normandie University, UNIROUEN, INSERM U1096 EnVI, Rouen, France.
Falvo, Nicolas; F-CRIN, INNOVTE, Saint-Etienne, France, Vascular Medicine Department, CHU Dijon, Dijon, France.
Juchet, Henry; Emergency Department, CHU Toulouse, Toulouse, France.
Nijkeuter, Mathilde; Department of emergency medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Mairuhu, Ronne; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands.
Faber, Laura M; Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, DTN, the Netherlands.
Mahé, Isabelle; Université Paris Cité, Paris, France, F-CRIN, INNOVTE, Saint-Etienne, France, Department of Internal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France, Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France.
Montaclair, Karine; F-CRIN, INNOVTE, Saint-Etienne, France, Department of Cardiology, CH Le Mans, Le Mans, France.
Planquette, Benjamin; Université Paris Cité, Paris, France, Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France, F-CRIN, INNOVTE, Saint-Etienne, France, Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France.
Jimenez, David; Respiratory Department and Medicine Department, Ramon y Cajal Hospital (IRYCIS) and Alcala University, CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Huisman, Menno V; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Klok, Federikus A; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Sanchez, Olivier; Université Paris Cité, Paris, France, Department of Pneumology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris F-75908, France, F-CRIN, INNOVTE, Saint-Etienne, France, Inserm UMR_S1140 Innovations Thérapeutiques en Hémostase, Paris, France. Electronic address: olivier.sanchez@aphp.fr.
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