MDCalc

EPIPHANY Index for Pulmonary Embolism (PE) in Cancer

Predicts risk of serious complications in cancer patients with pulmonary embolism.

Use in adults (>18 years) with cancer and PE (symptomatic or incidental) confirmed on imaging (i.e., CT, CT angiography, V/Q scan). Do not use if PE diagnosed >1 month before cancer diagnosis, or if PE diagnosed >1 month since completing chemotherapy.

Step 1: Clinical decision rule (CDR) - positive if any of the following are true:

Systolic BP, mmHg
Arterial O₂ saturation
Respiratory rate, breaths/min
Pulse, beats/min
Sudden or progressive dyspnea
Clinically relevant hemorrhage, risk of bleeding, or platelets <50,000/mm³

Result:

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Management
  • High-risk patients most likely require inpatient management.
  • For intermediate risk patients, clinical judgment should be used. Observation may be appropriate for many of these patients.
  • Low-risk patients may be candidates for outpatient management in selected cases.
Critical Actions

When starting anticoagulation therapy, consider the following factors: patient weight, liver and kidney function, platelet count, bleeding or risk of bleeding, and other significant comorbidities.

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