Outpatient management of cancer-associated pulmonary embolism: a systematic review and meta-analysis

Outpatient management of pulmonary embolism (PE) remains controversial in patients with cancer due to their higher risks of mortality, recurrent venous thromboembolism (VTE) and bleeding complications. This systematic review and meta-analysis aimed to evaluate the safety and feasibility of outpatient management of cancer-associated PE.

We searched MEDLINE, Embase, Cochrane Central and Scopus databases from inception to 30 May 2024 for studies on outpatient management of cancer-associated PE. Eligible studies included randomised controlled trials, cohort studies and case-control studies with at least 10 patients. The primary outcome was 30-day all-cause mortality; secondary outcomes included VTE-related mortality, major bleeding and recurrent VTE at 30 days. Meta-analysis was performed using random effects models and heterogeneity was assessed with the I²-statistic.

19 studies (13 full articles, six abstracts only) with a total of 1675 patients managed as outpatients were identified. Criteria for outpatient management of cancer-associated PE were reported in 14 studies. The pooled 30-day all-cause mortality rate was 1.74% (95% CI 0.99-3.03%; I²=0%; 691 patients, six full articles). The 30-day major bleeding pooled rate was 2.71% (95% CI 1.51-4.83%; I²=0%; 406 patients, six full articles) and the 30-day recurrent VTE pooled rate was 1.26% (95% CI 0.53-3.00%; I²=0%; 396 patients, five full articles).

Selected patients with cancer-associated PE managed as outpatients appear to have low short-term rates of mortality, major bleeding and recurrent VTE, suggesting this may be a safe strategy. Further research with larger, prospective studies is needed to confirm these findings and refine risk stratification protocols.