Complications developing during hospitalization in cases of malignant pulmonary thromboembolism

ABSTRACT COMPLICATIONS DEVELOPING DURING HOSPITALIZATION IN CASES OF MALIGNANT PULMONARY THROMBOEMBOLISM Objective: Pulmonary thromboembolism (PTE), with its increasing incidence and decreasing mortality rate, is currently one of the most common causes of cardiovascular mortality. Although outpatient treatment is recommended in certain cases, the majority of venous thromboembolism (VTE) patients are still treated in hospital for at least six days. The presence of cancer constitutes a high risk according to the simplified Pulmonary Embolism Severity Index (sPESI) score; therefore, outpatient management of these patients is generally not recommended in the literature. However, in clinical practice, a significant proportion of such patients do not experience any complications during hospitalization, suggesting that those without in-hospital complications might be eligible for outpatient treatment. Materials and Methods: This study retrospectively analyzed 250 patients with a diagnosis of PTE and concomitant malignancy who were admitted to the Department of Pulmonology at Karadeniz Technical University Faculty of Medicine Farabi Hospital between 2019 and 2023. Demographic data, clinical and laboratory findings during follow-up, as well as sPESI and Hestia scores, were recorded, and the development of complications was evaluated. Results: Lung cancer was the most frequently observed malignancy. The mean sPESI score was 1.6 ± 0.9, and the mean Hestia score was 1.2 ± 1.4. Both scores were significantly higher in symptomatic patients. At least one complication, including death, occurred in 13.6% of patients; the most common complications were bleeding and pain, while no cases of re-embolism were observed. Among patients whose sPESI score was 1 solely due to malignancy, the incidence of all complications, including death, was significantly lower than in those with sPESI scores greater than 1. Conclusion: In malignant PTE cases, the presence of symptoms at presentation, clinical scores, and metastasis were found to be closely associated with complication development. These findings underscore the importance of close monitoring, individualized treatment planning, and early prediction of potential complications in malignant PTE patients. Notably, patients who presented asymptomatically and had an sPESI score of 1 solely due to malignancy exhibited significantly lower complication rates, indicating that this subgroup may be eligible for outpatient management. However, further large-scale randomized controlled trials are needed to evaluate other complications not observed in our study. Keywords: Pulmonary Thromboembolism, Malignancy, Complications, Cancer-Associated Thrombosis