Percutaneous embolectomy vs medical therapy for acute pulmonary embolism in patients with cancer

Cancer-associated acute pulmonary embolism (PE) carries high morbidity and mortality, compounded by elevated bleeding risks. While percutaneous therapies are increasingly utilized, robust comparative effectiveness data in this high-risk oncologic population remain scarce.

To evaluate temporal trends, safety, and clinical outcomes of percutaneous embolectomy versus medical therapy in cancer patients presenting with acute PE.

We analyzed the National Inpatient Sample (2016-2021) for adult cancer patients hospitalized with acute PE. Patients were stratified by receipt of percutaneous embolectomy or medical therapy alone. The primary outcome was in-hospital mortality. Propensity-score matching (PSM) (1:3) was utilized to adjust for baseline demographics and hospital characteristics.

Among 476,915 weighted hospitalizations, 2760 (0.6%) underwent percutaneous embolectomy. Utilization increased significantly from 0.16% in 2016 to 1.35% in 2021. The embolectomy cohort exhibited substantially higher baseline clinical acuity, including elevated rates of PE-related shock (46.6% vs 5.2%; P < 0.001). After PSM (n = 11,040), in-hospital mortality did not differ significantly between the percutaneous and medical therapy groups (OR: 0.87; 95% CI: 0.63-1.21). The embolectomy cohort demonstrated similar rates of major bleeding (OR: 0.95; 95% CI: 0.61-1.48) but higher rates of acute kidney injury (OR: 1.36; 95% CI: 1.09-1.71).

In cancer patients with acute PE, percutaneous embolectomy utilization is rapidly increasing. Despite being performed in a cohort with profound hemodynamic instability, embolectomy was associated with comparable survival and major bleeding rates to medical management.