Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations-State-of-the-Art

Evangelos Dimakakos, Georgia Gomatou (Lead / Corresponding author), Mariella Catalano, Dan-Mircea Olinic, Alex C. Spyropoulos, Anna Falanga, Anthony Maraveyas, Aaron Liew, Sam Schulman, Jill Belch, Grigorios Gerotziafas, Peter Marschang, Benilde Cosmi, Jonas Spaak, Konstantinos Syrigos, , , , ,

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
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Abstract

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist.

Original languageEnglish
Pages (from-to)3261-3274
Number of pages14
JournalAnticancer Research
Volume42
Issue number7
Early online date5 Jul 2022
DOIs
Publication statusPublished - Jul 2022

Keywords

  • Anticoagulants/therapeutic use
  • COVID-19/complications
  • Endothelial Cells
  • Heparin, Low-Molecular-Weight/therapeutic use
  • Humans
  • Neoplasms/complications
  • Prospective Studies
  • RNA, Viral
  • Risk Factors
  • SARS-CoV-2
  • Thrombosis/drug therapy
  • Venous Thromboembolism/drug therapy
  • Anticoagulation
  • COVID-19
  • review
  • CAT
  • thromboprophylaxis

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