An increased risk of thromboembolic events (TE) is associated with COVID-19 infection. However, information available about thrombosis risk in COVID-19 cancer patients (Ca-P) is still scarce.
We retrospectively evaluated 219 Ca-P who were diagnosed of COVID-19 infection in our institution during the first pandemic wave. The study population was monitored for 12 months, and TE were recorded. A descriptive analysis of baseline and follow-up clinical characteristics was performed. Potential prognostic factors for developing TE and overall survival (OS) were analysed using logistic and cox proportional regression models.
Overall TE rate was 13%. Median time from COVID-19 diagnosis to TE was 12 weeks (w). TE reported during COVID-19 hospitalization (52%) conferred poorer survival compared to those whose TE was diagnosed during follow-up (12 vs 52 w, p=0.02). No differences in OS were found between patients who developed TE and those who did not. Reported TE included pulmonary embolism (68%), deep vein thrombosis (16%), and other arterial thrombosis (16%). Arterial thrombosis that led to a major ischemic event (ischemic stroke, limb ischemia, bowel ischemia) resulted in worse survival outcomes (1 vs 37 w, p=0.01). Pooled mortality rate among patients with TE was 52%, and 41% among patients without TE. On multivariate (Mv) analysis, only acute respiratory distress syndrome, metastatic disease, poor performance status, and history of TE before COVID-19 diagnosis remained significant predictors for poorer survival, and thromboprophylaxis during COVID-19 hospitalization as a predictor for better survival outcomes. Univariate analysis revealed haemoglobin <10g/dL, D-dimer >3000 ng/mL, PCR >5 ng/mL, LDH >190 UI/L and ferritin > 296 ng/mL during follow-up as significant prognostic factors for TE. Only ferritin > 296 ng/mL remained significant after Mv analysis. Neither being on any specific oncological treatment nor prior anticoagulant therapy influenced TE risk. No major bleeding was reported.
TE in COVID-19 Ca-P can lead to fatal outcomes. Thrombotic risk may persist after acute infection; therefore, routine active surveillance should be considered. Larger studies are needed for developing a risk prediction tool for TE in COVID-19 Ca-P.
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All authors have declared no conflicts of interest.