Practical considerations about management of pulmonary embolism in patients with cancer

Venous thromboembolism in cancer patients constitutes a complex and clinically significant disease due to its pathophysiology, morbidity and mortality. Pulmonary embolism is a potentially life-threatening disease, and therefore it represents the second leading cause of death among cancer patients, surpassed only by cancer itself. In recent years, direct-acting oral anticoagulants have emerged as the preferred option for the treatment of cancer-related venous thromboembolism, although low-molecular weight heparins are still specifically recommended for patients with high bleeding risk. The management of anticoagulant therapy beyond the first 6 months following pulmonary embolism remains a challenging scenario, requiring careful evaluation of the balance between benefits and risks. Anti-thrombotic prophylaxis is not routinely recommended in the outpatient setting, although emerging data suggest validated risk tools could help identify high-risk populations who might benefit. This review summarizes available clinical trial data, meta-analyses, real-world studies, both national and international guidelines providing a practical approach to the management of pulmonary embolism in patients with cancer.