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

• Published in: Anticancer research Vol. 42; no. 7; pp. 3261 - 3274
• Main Authors: DIMAKAKOS, EVANGELOS, GOMATOU, GEORGIA, CATALANO, MARIELLA, OLINIC, DAN-MIRCEA, SPYROPOULOS, ALEX C., FALANGA, ANNA, MARAVEYAS, ANTHONY, LIEW, AARON, SCHULMAN, SAM, BELCH, JILL, GEROTZIAFAS, GRIGORIOS, MARSCHANG, PETER, COSMI, BENILDE, SPAAK, JONAS, SYRIGOS, KONSTANTINOS
• Format: Journal Article Web Resource
• Language: English
• Published: Athens International Institute of Anticancer Research 01.07.2022
• Subjects: Anticoagulants; Anticoagulants/therapeutic use; Anticoagulation; Cancer; Cancer Research; Cardiology and Cardiovascular Disease; Cardiovascular & respiratory systems; CAT; Clinical Medicine; Clinical trials; Coagulation; COVID-19; COVID-19/complications; Endothelial Cells; Epidemiology; Fatalities; Heparin; Heparin, Low-Molecular-Weight; Heparin, Low-Molecular-Weight/therapeutic use; Human health sciences; Humans; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Life Sciences; Low molecular weights; Medical and Health Sciences; Medicin och hälsovetenskap; Molecular weight; Mortality; Neoplasms; Neoplasms/complications; Neoplasms/drug therapy; Oncology; Prospective Studies; review; Risk assessment; Risk Factors; RNA, Viral; SARS-CoV-2; Sciences de la santé humaine; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Subgroups; Systèmes cardiovasculaire & respiratoire; Thromboembolism; thromboprophylaxis; Thrombosis; Thrombosis/drug therapy; Thrombosis/etiology; Thrombosis/prevention & control; Venous Thromboembolism; Venous Thromboembolism/drug therapy; Venous Thromboembolism/etiology; Venous Thromboembolism/prevention & control; COVID-19 Crisis; Antithrombotic treatment; Cancer associated thrombosis (CAT); COVID-19 Coronavirus; Thromboprophylaxis; Anticoagulation; Thrombosis
• ISSN: 0250-7005; 1791-7530; 1791-7530
• DOI: 10.21873/anticanres.15815

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.