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

TY - JOUR

T1 - Thromboembolic Disease in Patients With Cancer and COVID-19

T2 - Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations-State-of-the-Art

AU - Dimakakos, Evangelos

AU - Gomatou, Georgia

AU - Catalano, Mariella

AU - Olinic, Dan-Mircea

AU - Spyropoulos, Alex C.

AU - Falanga, Anna

AU - Maraveyas, Anthony

AU - Liew, Aaron

AU - Schulman, Sam

AU - Belch, Jill

AU - Gerotziafas, Grigorios

AU - Marschang, Peter

AU - Cosmi, Benilde

AU - Spaak, Jonas

AU - Syrigos, Konstantinos

N1 - Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

KW - Anticoagulants/therapeutic use

KW - COVID-19/complications

KW - Endothelial Cells

KW - Heparin, Low-Molecular-Weight/therapeutic use

KW - Humans

KW - Neoplasms/complications

KW - Prospective Studies

KW - RNA, Viral

KW - Risk Factors

KW - SARS-CoV-2

KW - Thrombosis/drug therapy

KW - Venous Thromboembolism/drug therapy

KW - Anticoagulation

KW - COVID-19

KW - review

KW - CAT

KW - thromboprophylaxis

UR - https://www.scopus.com/pages/publications/85133288196

U2 - 10.21873/anticanres.15815

DO - 10.21873/anticanres.15815

M3 - Review article

C2 - 35790272

SN - 0250-7005

VL - 42

SP - 3261

EP - 3274

JO - Anticancer Research

JF - Anticancer Research

IS - 7

ER -