Hospital length of stay in patients with cancer who undergo systemic or ultrasound-catheter-directed thrombolysis for pulmonary embolism.
Authors: Ostos Catherine , Menchaca Kristina D. , Jones Can X. , Velez-Quinones Virginia , Ostos Erika , Draguljevic Nemanja , Chait Robert 
Published: June 2023

e22521

Background: Pulmonary Embolism is a common cause of morbidity and mortality in patients with cancer. Current treatment can be done depending on severity with Catheter-Directed Thrombolysis (CDT), which can have addition of ultrasound to it (EKOS brand US-CDT), or Systemic Thrombolysis (ST). There is limited data regarding its use and different outcomes in population with cancer. We conducted a retrospective cohort study to identify characteristics and hospital length of stay, in patients with PE who underwent either treatment, comparing patients with and without cancer. Methods: This retrospective cohort study identified 1,270 patients across several facilities diagnosed with Pulmonary Embolism with and without cancer. Patients who had pregnancy, stroke, and bleeding were excluded, with a final sample of 1007 patients. Patients were stratified into two groups based on the treatment they received, a group who underwent Ultrasound-Catheter-Directed Thrombolysis (US-CDT) with EKOS brand (575 patients 57.1%), and a group who received Systemic Thrombolysis (ST) (432 patients 42.9%). Patients subsequently were divided in patients who had cancer (n = 66) and those who did not have cancer (n = 941). We assessed patient’s characteristics such as hypertension (HTN), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and events during hospitalization. The primary outcome was hospital length of stay with either treatment and compare it in patients with and without cancer. Negative binomial regression was used to determine the association and prediction for length of stay according to different characteristics. Results: Of the 1007 patients with PE who received either Ultrasound-Catheter-Directed or Systemic Thrombolysis, the mean age was 58.65 years, 45.78% were female and 54.22% were male. The mean length of stay (LOS) was 7.41 days. The maximum length of stay was 143 days. There was no relationship between the type of treatment used for the PE and the length of stay. Patients with cancer compared to patients without cancer are more likely with an incidence rate ratio (IRR) of 1.479 (P < 0.0001, CI 1.228~ 1.78) to have an extended length of stay. Conclusions: Patients with cancer have more risks of complications from cancer and thrombosis. In the case of thrombosis associated with cancer, especially pulmonary embolism, there is limited data regarding different treatment options for it for this population. Although there was no difference in LOS with either US-CDT and ST, our study is the first one to identify that patients with cancer and PE who are more likely to have extended length of stay (IRR = 1.479 P < 0.0001, CI 1.228~ 1.78) regardless of treatment with ST or US-CDT. However, the limitation is having a relatively small sample size, and other possible confounders from the patients and the disease itself. Further research is required to investigate this.