Comorbid cancer and use of thrombolysis in acute pulmonary embolism

Guidelines suggest the use of thrombolytic therapy for acute pulmonary embolism (PE) patients with hypotension who are not at high-risk of bleeding. Data describing the use of thrombolysis in patients with cancer are scarce. The aim of this study was to evaluate the relationship between cancer and the use of thrombolysis for acute PE. The 2013 and 2014 US National Inpatient Sample was used to identify admissions for acute PE. Identified admissions were stratified based on the presence or absence of cancer. Multivariable logistic regression was performed to determine the association between comorbid cancer and the odds of receiving thrombolysis after adjustment for patient- and hospital-level covariates. In those receiving thrombolysis, the association between cancer and in-hospital mortality was determined using logistic regression after adjusting for age ≥ 65 years and sex. We identified 72,546 admissions for acute PE; of which, 14.7% (n = 10,673) had comorbid cancer. A total of 3.4% (n = 2439) of patients received thrombolysis. Upon multivariable adjustment, cancer was associated with decreased odds of receiving thrombolysis (odds ratio = 0.55; 95% confidence interval = 0.48-0.64). When the population was restricted to PE admissions receiving thrombolysis, mortality occurred in 315 (12.9%) admissions; with no difference in in-hospital mortality observed between those with versus without cancer (p = 0.11). In this study of admissions for acute PE, comorbid cancer was associated with decreased odds of receiving thrombolysis. As PE is a common complication among patients with cancer, the risk-benefit profile of thrombolysis in this patient population should be determined.