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Chapter 20 - Near Syncope

Published online by Cambridge University Press:  24 April 2026

By
Jonathan Rowland and
Aiham Qdaisat
Edited by
Angela Bray Lindsay and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. Management for massive pulmonary embolism (PE) requires hemodynamic stabilization and consider consulting interventional radiology or surgical specialists for intermediate-high risk cases.

2. Initiation of anticoagulation for incidental PE in patients with cancer is generally recommended if no contraindications exists, especially when the PE is proximal or if the patient has other risk factors such as decreased mobility.

3. Confirm the patient’s code status and/or goals of care prior to initiating aggressive interventions that may not align with the patient’s wishes

4. .Utilization of the Pulmonary Embolism Severity Index (PESI) score helps to risk stratify patients based on risk of 30-day mortality.

5. Patients who are low-intermediate risk without contraindications on the American Heart Association/European Society of Cardiology Guidelines for PE Risk Stratification can be discharged with close follow-up and initiation of either low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC).

Keywords

Pulmonary embolismcancermalignancyright heart strainechocardiographyanticoagulationthrombectomymassivesubmassivepulmonary embolism severity indexPESIKhorana

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 97 - 104
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Bernal, AG, Fanola, C, Bartos, JA. Management of PE. American College of Cardiology. Accessed December 12, 2024. www.acc.org/Latest-in-Cardiology/Articles/2020/01/27/07/42.Google Scholar
Delluc, A, Ianotto, JC, Tromeur, C, De Moreuil, C, Couturaud, F, Lacut, K, et al. Real-world incidence of cancer following a first unprovoked venous thrombosis: results from the EPIGETBO study. Thrombosis Research. 2018;164:79–84.CrossRefGoogle ScholarPubMed
Key, NS, Khorana, AA, Kuderer, NM, Bohlke, K, Lee, AYY, Arcelus, JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Guideline Update. J Clin Oncol. 2023;41(16):3063–3071.CrossRefGoogle ScholarPubMed
Meyer, G, Marjanovic, Z, Valcke, J, et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med. 2002;162(15):1729–1735. https://doi.org/10.1001/archinte.162.15.1729.CrossRefGoogle Scholar
Pettit, NR, Kline, JA. Venous thromboembolism. In: Todd, KH, Thomas Jr Charles, R, Alagappan, K (eds.). Oncologic Emergency Medicine: Principles and Practice [Internet]. Springer International Publishing 2021 [accessed June 26, 2024] pp. 317–326. https://doi.org/10.1007/978-3-030-67123-5_24.CrossRefGoogle Scholar
Prandoni, P, Lensing, AWA, Prins, MH, Villalta, S, Negri, S, Piccioli, A, et al. Venous thrombotic burden and the risk of subsequent overt cancer. Thromb Haemost. 2015;114(4):864–865.Google ScholarPubMed
Rouleau, SG, Casey, SD, Kabrhel, C, Vinson, DR, Long, B. Management of high-risk pulmonary embolism in the emergency department: a narrative review. Am J Emerg Med. 2024;79:1–11.CrossRefGoogle ScholarPubMed

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