Tromboembolismo Pulmonar en Pacientes con Cáncer
Resumen
El embolismo pulmonar (EP) es una patología bien conocida y delimitada que se asocia fuertemente al antecedente de cáncer, delimitando un subgrupo de pacientes con clínica que, aunque es compatible con la clásica también puede variar, así como el abordaje diagnóstico en presencia de malignidad. El manejo par todos los pacientes con EP definitivamente es la anticoagulación, con agentes intravenosos o subcutaneos como las heparinas de bajo peso molecular (HBPM) o los anticoagulantes directos orales (DOAC), según el perfil de estos pacientes. La evidencia reciente en cuanto al manejo a corto y largo plazo de pacientes con cáncer y EP podría cambiar la perspectiva del manejo y abre la puerta a la elección del clínico del agente que decide formular según las condiciones del paciente, sus antecedentes y preferencias.
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Agnelli, G., Becattini, C., Meyer, G., Muñoz, A., Huisman, M. v., Connors, J. M., Cohen, A., Bauersachs, R., Brenner, B., Torbicki, A., Sueiro, M. R., Lambert, C., Gussoni, G., Campanini, M., Fontanella, A., Vescovo, G., & Verso, M. (2020). Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. New England Journal of Medicine, 382(17), 1599–1607. https://doi.org/10.1056/nejmoa1915103
Anagnostopoulos, I., Lagou, S., Spanorriga, M. K., Tavernaraki, K., Poulakou, G., Syrigos, K. N., & Thanos, L. (2020). Epidemiology and diagnosis of pulmonary embolism in lung cancer patients: is there a role for age adjusted D-dimers cutoff? Journal of Thrombosis and Thrombolysis, 49(4), 572–577. https://doi.org/10.1007/s11239-019-02003-8
Castro-Sandoval, P., Barrós-González, R., Galindo-Martín, M. A., Ruiz-Grinspan, M. S., & Rodríguez-Leal, C. M. (2022). Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias. Medicina Clínica, 159(10), 483–485. https://doi.org/10.1016/j.medcli.2022.03.016
Chan, N., Sobieraj-Teague, M., & Eikelboom, J. W. (2020). Direct oral anticoagulants: evidence and unresolved issues. The Lancet, 396(10264), 1767–1776. https://doi.org/10.1016/S0140-6736(20)32439-9
Charland, S. L., & Klinter, D. E. (1998). Low-Molecular-Weight Heparins in the Treatment of Pulmonary Embolism. Annals of Pharmacotherapy, 32(2), 258–264. https://doi.org/10.1345/aph.16474
Donadini, M. P., Dentali, F., Squizzato, A., Guasti, L., & Ageno, W. (2014). Unsuspected pulmonary embolism in cancer patients: A narrative review with pooled data. In Internal and Emergency Medicine (Vol. 9, Issue 4, pp. 375–384). Springer-Verlag Italia s.r.l. https://doi.org/10.1007/s11739-014-1066-7
dos Santos Fernandes, C. J. C., & Couturaud, F. (2021). Moving forward for incidental pulmonary embolism in cancer patients. In European Respiratory Journal (Vol. 58, Issue 1). European Respiratory Society. https://doi.org/10.1183/13993003.04630-2020
Droppa, M., Zdanyte, M., Henes, J. K., Gawaz, M., Borst, O., & Rath, D. (2023). Continuous low-dose thrombolysis in patients with intermediate-high risk pulmonary embolism: A retrospective analysis. Thrombosis Research, 226, 33–35. https://doi.org/10.1016/j.thromres.2023.04.006
Duffett, L., Castellucci, L. A., & Forgie, M. A. (2020). Pulmonary embolism: Update on management and controversies. In The BMJ (Vol. 370). BMJ Publishing Group. https://doi.org/10.1136/bmj.m2177
Frere, C., Farge, D., Schrag, D., Prata, P. H., & Connors, J. M. (2022). Direct oral anticoagulant versus low molecular weight heparin for the treatment of cancer-associated venous thromboembolism: 2022 updated systematic review and meta-analysis of randomized controlled trials. In Journal of Hematology and Oncology (Vol. 15, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13045-022-01289-1
Gimbel, I. A., Mulder, F. I., Bosch, F. T. M., Freund, J. E., Guman, N., van Es, N., Kamphuisen, P. W., Büller, H. R., & Middeldorp, S. (2021). Pulmonary embolism at autopsy in cancer patients. Journal of Thrombosis and Haemostasis, 19(5), 1228–1235. https://doi.org/10.1111/jth.15250
Giordano, N. J., Jansson, P. S., Young, M. N., Hagan, K. A., & Kabrhel, C. (2017). Epidemiology, Pathophysiology, Stratification, and Natural History of Pulmonary Embolism. Techniques in Vascular and Interventional Radiology, 20(3), 135–140.
https://doi.org/10.1053/j.tvir.2017.07.002
Girardi, A. M., Bettiol, R. S., Garcia, T. S., Ribeiro, G. L. H., Rodrigues, É. M., Gazzana, M. B., & Rech, T. H. (2020). Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study. Journal of Intensive Care Medicine, 35(10), 1112–1117. https://doi.org/10.1177/0885066618816280
Güner, A., Kalçik, M., Aykan, A. Ç., Gürsoy, M. O., Kalkan, A. K., Astarcioğlu, M. A., Ertürk, M., Uzun, F., Güner, E. G., Yildiz, M., & Özkan, M. (2020). Clinical safety and efficacy of thrombolytic therapy with low-dose prolonged infusion of tissue type plasminogen activator in patients with intermediate-high risk pulmonary embolism. Blood Coagulation & Fibrinolysis, 31(8), 536–542. https://doi.org/10.1097/MBC.0000000000000960
Haque, F., Ryde, J., Broughton, L., Huang, C., Sethi, S., Stephens, A., Pillai, A., Mirza, S., Brown, V., Avery, G., Bozas, G., & Maraveyas, A. (2023). Validation of the HULL Score clinical prediction rule for unsuspected pulmonary embolism in ambulatory cancer patients. ERJ Open Research, 9(3), 00651–02022. https://doi.org/10.1183/23120541.00651-2022
Howard, L. (2019). Acute pulmonary embolism. In Clinical Medicine (Vol. 19).
Iwuji, K., Almekdash, H., Nugent, K. M., Islam, E., Hyde, B., Kopel, J., Opiegbe, A., & Appiah, D. (2021). Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis. In Journal of Primary Care and Community Health (Vol. 12). SAGE Publications Inc. https://doi.org/10.1177/21501327211054996
Kahn, S. R., & de Wit, K. (2022). Pulmonary Embolism. New England Journal of Medicine, 387(1), 45–57. https://doi.org/10.1056/NEJMcp2116489
Kearon, C., de Wit, K., Parpia, S., Schulman, S., Afilalo, M., Hirsch, A., Spencer, F. A., Sharma, S., D’Aragon, F., Deshaies, J.-F., le Gal, G., Lazo-Langner, A., Wu, C., Rudd-Scott, L., Bates, S. M., & Julian, J. A. (2019). Diagnosis of Pulmonary Embolism with d -Dimer Adjusted to Clinical Probability. New England Journal of Medicine, 381(22), 2125–2134. https://doi.org/10.1056/NEJMoa1909159
Kim, M. S., Chang, H., Lee, S. Y., Shin, S. H., Park, H., Chang, S. A., Park, T. K., Kim, D. K., & Kim, E. K. (2020). Differential clinical manifestations and clinical outcome of cancer-related pulmonary embolism. Korean Journal of Internal Medicine, 35(2), 360–368. https://doi.org/10.3904/kjim.2018.267
KLINE, J. A., COURTNEY, D. M., KABRHEL, C., MOORE, C. L., SMITHLINE, H. A., PLEWA, M. C., RICHMAN, P. B., O’NEIL, B. J., & NORDENHOLZ, K. (2008). Prospective multicenter evaluation of the pulmonary embolism rule‐out criteria. Journal of Thrombosis and Haemostasis, 6(5), 772–780. https://doi.org/10.1111/j.1538-7836.2008.02944.x
Konstantinides, S. v., Meyer, G., Bueno, H., Galié, N., Gibbs, J. S. R., Ageno, W., Agewall, S., Almeida, A. G., Andreotti, F., Barbato, E., Baumbach, A., Beygui, F., Carlsen, J., de Carlo, M., Delcroix, M., Subias, P. E., Gaine, S., Goldhaber, S. Z., Gopalan, D., … Pepke-Zaba, J. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). In European Heart Journal (Vol. 41, Issue 4, pp. 543–603). Oxford University Press. https://doi.org/10.1093/eurheartj/ehz405
Lehnert, P., Lange, T., Møller, C., Olsen, P., & Carlsen, J. (2018). Acute Pulmonary Embolism in a National Danish Cohort: Increasing Incidence and Decreasing Mortality. Thrombosis and Haemostasis, 118(03), 539–546. https://doi.org/10.1160/TH17-08-0531
Leiva, O., Newcomb, R., Connors, J. M., & Al-Samkari, H. (2020). Cancer and thrombosis: new insights to an old problem. JMV-Journal de Medecine Vasculaire, 45(6), 6S8-6S16. https://doi.org/10.1016/S2542-4513(20)30514-9
Licha, C. R. M., McCurdy, C. M., Maldonado, S. M., & Lee, L. S. (2020). Current management of acute pulmonary embolism. In Annals of Thoracic and Cardiovascular Surgery (Vol. 26, Issue 2, pp. 65–71). Japanese Association for Coronary Artery Surgery. https://doi.org/10.5761/atcs.ra.19-00158
McBane, R. D., Wysokinski, W. E., Le-Rademacher, J. G., Zemla, T., Ashrani, A., Tafur, A., Perepu, U., Anderson, D., Gundabolu, K., Kuzma, C., Perez Botero, J., Leon Ferre, R. A., Henkin, S., Lenz, C. J., Houghton, D. E., Vishnu, P., & Loprinzi, C. L. (2020). Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. Journal of Thrombosis and Haemostasis, 18(2), 411–421. https://doi.org/10.1111/jth.14662
Planquette, B., Bertoletti, L., Charles-Nelson, A., Laporte, S., Grange, C., Mahé, I., Pernod, G., Elias, A., Couturaud, F., Falvo, N., Sevestre, M. A., Ray, V., Burnod, A., Brebion, N., Roy, P.-M., Timar-David, M., Aquilanti, S., Constans, J., Bura-Rivière, A., … Sanchez, O. (2022). Rivaroxaban vs Dalteparin in Cancer-Associated Thromboembolism. Chest, 161(3), 781–790. https://doi.org/10.1016/j.chest.2021.09.037
Pollack, C. v., Schreiber, D., Goldhaber, S. Z., Slattery, D., Fanikos, J., O’Neil, B. J., Thompson, J. R., Hiestand, B., Briese, B. A., Pendleton, R. C., Miller, C. D., & Kline, J. A. (2011). Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: Initial report of EMPEROR (multicenter emergency medicine pulmonary embolism in the real world registry). Journal of the American College of Cardiology, 57(6), 700–706. https://doi.org/10.1016/j.jacc.2010.05.071
Qdaisat, A., Kamal, M., Al-Breiki, A., Goswami, B., Wu, C. C., Zhou, S., Rice, T. W., Alagappan, K., & Yeung, S. C. J. (2020). Clinical characteristics, management, and outcome of incidental pulmonary embolism in cancer patients. Blood Advances, 4(8), 1606–1614. https://doi.org/10.1182/bloodadvances.2020001501
Raskob, G. E., van Es, N., Verhamme, P., Carrier, M., di Nisio, M., Garcia, D., Grosso, M. A., Kakkar, A. K., Kovacs, M. J., Mercuri, M. F., Meyer, G., Segers, A., Shi, M., Wang, T.-F., Yeo, E., Zhang, G., Zwicker, J. I., Weitz, J. I., & Büller, H. R. (2018). Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. New England Journal of Medicine, 378(7), 615–624. https://doi.org/10.1056/nejmoa1711948
Shen, J. H., Chen, H. L., Chen, J. R., Xing, J. L., Gu, P., & Zhu, B. F. (2016). Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis. Journal of Thrombosis and Thrombolysis, 41(3), 482–492. https://doi.org/10.1007/s11239-015-1250-2
Stals, M. A. M., Takada, T., Kraaijpoel, N., van Es, N., Büller, H. R., Courtney, D. M., Freund, Y., Galipienzo, J., le Gal, G., Ghanima, W., Huisman, M. v., Kline, J. A., Moons, K. G. M., Parpia, S., Perrier, A., Righini, M., Robert-Ebadi, H., Roy, P. M., van Smeden, M., … Klok, F. A. (2022). Safety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups A Systematic Review and Individual-Patient Data Meta-analysis. In Annals of Internal Medicine (Vol. 175, Issue 2, pp. 244–255). American College of Physicians. https://doi.org/10.7326/M21-2625
Surgit, O. (2023). Low-dose thrombolytic therapy versus unfractionated heparin in patients with intermediate-high risk pulmonary embolism. Turkish Journal of Trauma and Emergency Surgery. https://doi.org/10.14744/tjtes.2023.55236
Tavoly, M., Utne, K. K., Jelsness-Jørgensen, L.-P., Wik, H. S., Klok, F. A., Sandset, P. M., & Ghanima, W. (2016). Health-related quality of life after pulmonary embolism: a cross-sectional study. BMJ Open, 6(11), e013086. https://doi.org/10.1136/bmjopen-2016-013086
van Es, N., Bleker, S. M., & di Nisio, M. (2014). Cancer-associated unsuspected pulmonary embolism. Thrombosis Research, 133(SUPPL. 2). https://doi.org/10.1016/S0049-3848(14)50028-X
Weeda, E. R., Hakamiun, K. M., Leschorn, H. X., & Tran, E. (2019). Comorbid cancer and use of thrombolysis in acute pulmonary embolism. Journal of Thrombosis and Thrombolysis, 47(2), 324–327. https://doi.org/10.1007/s11239-018-1772-5
Werth, S., & Beyer-Westendorf, J. (2018). Diagnosis and Treatment of Pulmonary Embolism in Challenging Populations. In Hamostaseologie (Vol. 38, Issue 2, pp. 87–96). Georg Thieme Verlag. https://doi.org/10.1055/s-0038-1641586
West, J., Goodacre, S., & Sampson, F. (2007). The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM, 100(12), 763–769. https://doi.org/10.1093/qjmed/hcm113
Yan, M., Kieser, R., Wu, C. C., Qiao, W., & Rojas-Hernandez, C. M. (2021). Clinical factors and outcomes of subsegmental pulmonary embolism in cancer patients. Blood Advances, 5(4), 1050–1058. https://doi.org/10.1182/bloodadvances.2020003136
Young, A. M., Marshall, A., Thirlwall, J., Chapman, O., Lokare, A., Hill, C., Hale, D., Dunn, J. A., Lyman, G. H., Hutchinson, C., Maccallum, P., Kakkar, A., Hobbs, F. D. R., Petrou, S., Dale, J., Poole, C. J., Maraveyas, A., & Levine, M. (2018). JOURNAL OF CLINICAL ONCOLOGY Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol, 36, 2017–2023. https://doi.org/10.1200/JCO
Derechos de autor 2023 Juan Sebastián Matamoros Muñox, Vivian Stefany Soto Rodriguez, Jorge Yamit Vargas Espitia
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.