Abstract：
BACKGROUND: Acute pulmonary embolism (PE) is a life-threatening situation in cancer patients. In this situation, anticoagulant therapy is complex to administer due to the risk of bleeding. Only few studies have been conducted when these patients are admitted to the intensive care unit (ICU). The aim of this study was to assess the association between anticoagulation strategies as well as other factors with 90-day mortality in patients with cancer and PE admitted to ICU. Major bleeding was also evaluated according to the type of anticoagulation.
METHODS: Retrospective study carried out in 4 ICUs in France over a 12-year period (2009-2021). All patients with cancer and PE were included. An overlap propensity score weighting analysis was performed in the subgroup of patients treated with either unfractionated heparins (UFH) alone or low-molecular-weight heparins (LMWH) alone on 90-day mortality and major bleeding.
RESULTS: A total of 218 consecutive cancer patients admitted to ICU and presenting PE were included. The 90-day mortality rate was 42 % for the global cohort. After propensity score analysis in the subgroup of patients treated with either \"UFH alone\" (n = 80) or \"LMWH alone\" (n = 71), the 90-day mortality was similar in patients treated with UFH alone (42.6 %) vs LMWH alone (39.9 %): OR = 1.124, CI 95 % [0.571-2.214], p = 0.750. There was a significant increased toward major bleeding rates in the \"UFH alone\" group (25.5 %) as compared to \"LMWH alone\" group (11.5 %), p = 0.04.
CONCLUSIONS: In 218 patients admitted to ICU and presenting PE, the 90-day mortality rate was 42 %. Treatment with UFH alone was associated with a mortality comparable to treatment with LMWH alone but it appeared to be more prone to major bleeding.
METHODS: Retrospective study carried out in 4 ICUs in France over a 12-year period (2009-2021). All patients with cancer and PE were included. An overlap propensity score weighting analysis was performed in the subgroup of patients treated with either unfractionated heparins (UFH) alone or low-molecular-weight heparins (LMWH) alone on 90-day mortality and major bleeding.
RESULTS: A total of 218 consecutive cancer patients admitted to ICU and presenting PE were included. The 90-day mortality rate was 42 % for the global cohort. After propensity score analysis in the subgroup of patients treated with either \"UFH alone\" (n = 80) or \"LMWH alone\" (n = 71), the 90-day mortality was similar in patients treated with UFH alone (42.6 %) vs LMWH alone (39.9 %): OR = 1.124, CI 95 % [0.571-2.214], p = 0.750. There was a significant increased toward major bleeding rates in the \"UFH alone\" group (25.5 %) as compared to \"LMWH alone\" group (11.5 %), p = 0.04.
CONCLUSIONS: In 218 patients admitted to ICU and presenting PE, the 90-day mortality rate was 42 %. Treatment with UFH alone was associated with a mortality comparable to treatment with LMWH alone but it appeared to be more prone to major bleeding.
摘要：
背景：急性肺栓塞（PE）是癌症患者的一种危及生命的情况。在这种情况下,抗凝治疗由于存在出血风险,给药很复杂.当这些患者被送入重症监护病房（ICU）时，仅进行了很少的研究。这项研究的目的是评估ICU收治的癌症和PE患者的抗凝策略以及其他因素与90天死亡率之间的关系。还根据抗凝类型评估大出血。
方法：在法国的4个ICU中进行了12年（2009-2021年）的回顾性研究。包括所有患有癌症和PE的患者。在90天死亡率和大出血时，对单独使用普通肝素（UFH）或单独使用低分子量肝素（LMWH）治疗的患者亚组进行了重叠倾向评分加权分析。
结果：共纳入218例连续入住ICU并出现PE的癌症患者。全球队列的90天死亡率为42%。在“单独使用UFH”（n=80）或“单独使用LMWH”（n=71）的患者亚组的倾向评分分析后，单用UFH(42.6%)与单用LMWH(39.9%)的患者90天死亡率相似:OR=1.124,CI95%[0.571-2.214],p=0.750。与“单独使用LMWH”组（11.5％）相比，“单独使用UFH”组（25.5％）的大出血率显着增加，p=0.04。
结论：在218例进入ICU并出现PE的患者中，90天死亡率为42%.单独使用UFH的治疗与单独使用LMWH的治疗相当的死亡率相关,但似乎更容易发生大出血。
方法：在法国的4个ICU中进行了12年（2009-2021年）的回顾性研究。包括所有患有癌症和PE的患者。在90天死亡率和大出血时，对单独使用普通肝素（UFH）或单独使用低分子量肝素（LMWH）治疗的患者亚组进行了重叠倾向评分加权分析。
结果：共纳入218例连续入住ICU并出现PE的癌症患者。全球队列的90天死亡率为42%。在“单独使用UFH”（n=80）或“单独使用LMWH”（n=71）的患者亚组的倾向评分分析后，单用UFH(42.6%)与单用LMWH(39.9%)的患者90天死亡率相似:OR=1.124,CI95%[0.571-2.214],p=0.750。与“单独使用LMWH”组（11.5％）相比，“单独使用UFH”组（25.5％）的大出血率显着增加，p=0.04。
结论：在218例进入ICU并出现PE的患者中，90天死亡率为42%.单独使用UFH的治疗与单独使用LMWH的治疗相当的死亡率相关,但似乎更容易发生大出血。
