INTRODUCTION 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. METHODS We searched MEDLINE, Embase, Cochrane Central, and Scopus databases from inception to May 30, 2024, for studies on outpatient management of cancer-associated PE. Eligible studies included randomized controlled trials, cohort studies, and case-control studies with ≥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. RESULTS Nineteen studies (13 full-article, 6 abstract-only) with a total of 1589 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, 6 full-article). The 30-day major bleeding pooled rate was 2.71% (95% CI: 1.51-4.83; I2=0%; 406 patients, 6 full-article), and the 30-day recurrent VTE pooled rate was 1.26% (95% CI: 0.53-3.00; I2=0%; 396 patients, 5 full-article). CONCLUSION 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.

中文翻译：

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癌症相关肺栓塞的门诊管理：系统评价和荟萃分析。


引言 肺栓塞 （PE） 的门诊治疗在癌症患者中仍然存在争议，因为他们的死亡风险较高、复发性静脉血栓栓塞 （VTE） 和出血并发症。本系统评价和荟萃分析旨在评估癌症相关 PE 门诊管理的安全性和可行性。方法 我们检索了从建库到 2024 年 5 月 30 日的 MEDLINE、Embase、Cochrane Central 和 Scopus 数据库，以查找癌症相关 PE 门诊管理的研究。符合条件的研究包括随机对照试验、队列研究和 ≥10 名患者的病例对照研究。主要结局是 30 天全因死亡率;次要结局包括 VTE 相关死亡率、大出血和 30 天复发性 VTE。使用随机效应模型进行 Meta 分析，并使用 I2 统计量评估异质性。结果 确定了 19 项研究 （13 篇全文，6 篇仅摘要），共涉及 1589 名门诊患者。14 项研究报告了癌症相关 PE 的门诊管理标准。汇总的 30 天全因死亡率为 1.74% （95% CI： 0.99-3.03;I2=0%，691 名患者，6 篇全文）。30 天大出血合并率为 2.71% （95% CI： 1.51-4.83;I2=0%;406 名患者，6 篇全文），30 天复发性 VTE 合并率为 1.26% （95% CI： 0.53-3.00;I2=0%;396 名患者，5 篇全文）。结论 在门诊接受治疗的选定癌症相关 PE 患者的短期死亡率、大出血率和复发性 VTE 似乎较低，这表明这可能是一种安全的策略。需要进一步研究更大规模的前瞻性研究来证实这些发现并改进风险分层方案。