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

Dimakakos, Evangelos ; Gomatou, Georgia ; Catalano, Mariella ; Olinic, Dan-Mircea ; Spyropoulos, Alex C ; Falanga, Anna ; Maraveyas, Anthony ; Liew, Aaron ; Schulman, Sam and Belch, Jill , et al. (2022) In Anticancer research 42(7). p.3261-3274
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... (More)

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.

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type
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publication status
published
subject
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
in
Anticancer research
volume
42
issue
7
pages
3261 - 3274
publisher
International Institute of Cancer Research
external identifiers
  • pmid:35790272
  • scopus:85133288196
ISSN
1791-7530
DOI
10.21873/anticanres.15815
language
English
LU publication?
yes
additional info
Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
id
872fd14a-8be0-4f5c-80ad-9148e0dc0446
date added to LUP
2023-08-31 09:18:19
date last changed
2025-10-17 13:21:49
@article{872fd14a-8be0-4f5c-80ad-9148e0dc0446,
  abstract     = {{<p>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.</p>}},
  author       = {{Dimakakos, Evangelos and Gomatou, Georgia and Catalano, Mariella and Olinic, Dan-Mircea and Spyropoulos, Alex C and Falanga, Anna and Maraveyas, Anthony and Liew, Aaron and Schulman, Sam and Belch, Jill and Gerotziafas, Grigorios and Marschang, Peter and Cosmi, Benilde and Spaak, Jonas and Syrigos, Konstantinos}},
  issn         = {{1791-7530}},
  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}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{3261--3274}},
  publisher    = {{International Institute of Cancer Research}},
  series       = {{Anticancer research}},
  title        = {{Thromboembolic Disease in Patients With Cancer and COVID-19 : Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations-State-of-the-Art}},
  url          = {{http://dx.doi.org/10.21873/anticanres.15815}},
  doi          = {{10.21873/anticanres.15815}},
  volume       = {{42}},
  year         = {{2022}},
}