What is the major bleeding rate for home treatment of cancer pulmonary embolism?
Treating pulmonary embolism (PE) at home is becoming more common for low-risk patients, but there has been concern about whether this is safe for people with active cancer. The major bleeding rate is a key safety measure. A recent trial specifically looked at this question in cancer patients and found a 4.6% rate of major bleeding over 3 months for those treated at home 6. This rate is similar to what has been seen in other studies of home treatment for PE, though those studies often excluded cancer patients 8.
What the research says
The ONCO PE trial, a multicenter randomized study in Japan, directly addressed home treatment for cancer-associated PE. Among 66 patients with low-risk PE (sPESI score of 1) who were treated at home with rivaroxaban, major bleeding occurred in 3 patients, giving a rate of 4.6% over 3 months 6. No patients in the home treatment group had a recurrent VTE or died from PE 6. For comparison, the in-hospital treatment group had a major bleeding rate of 1.8% 6. These results suggest that home treatment is feasible for carefully selected cancer patients with low-risk PE.
Earlier studies also support the safety of home treatment for PE, though they often excluded or had few cancer patients. A 2015 study of low-risk VTE patients treated at home with rivaroxaban reported no major bleeding events in 106 patients, but only a small number had cancer 8. A 2014 study of cancer patients with PE found that those treated at home had similar rates of major bleeding and recurrence compared to those treated in the hospital, though the home-treated group mostly had incidental (not symptomatic) PE 9.
It is important to note that the ONCO PE trial used strict selection criteria: all patients had a low sPESI score (1 point) and were treated with a specific anticoagulant (rivaroxaban) 6. The major bleeding rate of 4.6% is based on a small number of events, so the confidence interval is wide (0.0% to 9.6%) 6. This means the true rate could be lower or higher.
What to ask your doctor
- Based on my cancer type and overall health, am I a candidate for home treatment of pulmonary embolism?
- What is my sPESI score, and does it indicate low risk?
- If I am treated at home, what signs of major bleeding should I watch for and when should I seek emergency care?
- How will my blood thinning medication be managed and monitored if I am at home?
- What follow-up appointments or tests will be needed after home treatment?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.