Font Carme, Cooksley Tim, Ahn Shin, Rapoport Bernardo, Escalante Carmen
Department of Internal Medicine, Hospital Clinic, Barcelona, Spain.
The Christie, Wilmslow Road, Manchester, M20 4BX UK.
Emerg Cancer Care. 2022;1(1):7. doi: 10.1186/s44201-022-00004-7. Epub 2022 Jun 20.
Venous thrombo-embolic (VTE) disease is a common cause of complications in patients with cancer and is the second most common cause of death in oncology patients other than the malignant disease. Whilst symptomatic VTE comprises the majority of such presentations to an emergency department (ED), incidental pulmonary embolism (IPE) is an increasingly frequent reason for attendance. Many studies report that the consequences of IPE do not differ significantly from those with symptomatic presentations and thus most guidelines recommend using the same approach. The complexity of treatment in cancer patients due to increased prevalence of co-morbidities, higher risk of bleeding, abnormal platelet and renal function, greater risk of VTE recurrence, and medications with the risk of anticoagulant interaction are consistent across patients with symptomatic and IPE. One of the initial challenges of the management of IPE is the design of a pathway that provides both patients and clinicians with a seamless journey from the radiological diagnosis of IPE to their initial clinical workup and management. Increased access to ambulatory care has successfully reduced ED utilisation and improved clinical outcomes in high-risk non-oncological populations, such as those with IPE. In this clinical review, we consider IPE management, its workup, the conundrums it may present for emergency physicians and the need to consider emergency ambulatory care for this growing cohort of patients.
静脉血栓栓塞（VTE）疾病是癌症患者并发症的常见原因，是肿瘤患者中仅次于恶性疾病的第二大常见死因。虽然有症状的VTE占急诊科此类就诊的大多数，但偶然发现的肺栓塞（IPE）是就诊的一个越来越常见的原因。许多研究报告称，IPE的后果与有症状表现的后果没有显著差异，因此大多数指南建议采用相同的方法。由于合并症患病率增加、出血风险更高、血小板和肾功能异常、VTE复发风险更大以及存在抗凝相互作用风险的药物，癌症患者的治疗复杂性在有症状的患者和IPE患者中是一致的。IPE管理的最初挑战之一是设计一条路径，为患者和临床医生提供从IPE的放射学诊断到其初始临床检查和管理的无缝流程。在高风险的非肿瘤人群（如IPE患者）中，增加门诊护理的可及性已成功减少了急诊科的使用并改善了临床结局。在本临床综述中，我们考虑了IPE的管理、其检查、它可能给急诊医生带来的难题以及为这一不断增加的患者群体考虑急诊门诊护理的必要性。
