MDCalc

EPIPHANY Index for Pulmonary Embolism (PE) in Cancer

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

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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Advice
  • This tool should not be the sole basis for care; clinicians should use their judgment and a full clinical evaluation. 
  • While the index allows clinicians to stratify risk of complications for patients with a PE, it has not yet been incorporated into clinical guidelines.
Management
  • Risk stratification may assist in clinical decision-making, but there are no formal recommendations from clinical guidelines using EPIPHANY Index risk categories. 
  • A higher score is associated with a higher risk of serious complications (major bleeding, need for ICU admission, CPR, non-invasive mechanical ventilation, orotracheal intubation, fibrinolysis, or any other event deemed serious by the investigator) and mortality.

Critical Actions

Regardless of score, clinicians should consider the risks and benefits of anticoagulation and make treatment recommendations that align with patient values and preferences.