Scientific article
Review
OA Policy
English

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

ContributorsDimakakos, 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; Cancer-COVID-19 thrombosis collaborative group; VAS-European Independent Foundation in Angiology/Vascular Medicine; UEMS Vascular Medicine/Angiology; European Society of Vascular Medicine; Balkan Working Group for Prevention and Treatment of Venous Thromboembolism; Hellenic Association of Lung Cancer
Published inAnticancer Research, vol. 42, no. 7, p. 3261-3274
Publication date2022-07
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.

Keywords
  • Anticoagulation
  • CAT
  • COVID-19
  • Review
  • Thromboprophylaxis
  • Anticoagulants / therapeutic use
  • COVID-19 / complications
  • Endothelial Cells
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Neoplasms / complications
  • Neoplasms / drug therapy
  • Prospective Studies
  • RNA, Viral
  • Risk Factors
  • SARS-CoV-2
  • Thrombosis / drug therapy
  • Thrombosis / etiology
  • Thrombosis / prevention & control
  • Venous Thromboembolism / drug therapy
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control
Citation (ISO format)
DIMAKAKOS, Evangelos et al. Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations-State-of-the-Art. In: Anticancer Research, 2022, vol. 42, n° 7, p. 3261–3274. doi: 10.21873/anticanres.15815
Main files (1)
Article (Published version)
Identifiers
Additional URL for this publicationhttps://ar.iiarjournals.org/content/42/7/3261
Journal ISSN0250-7005
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Creation09/13/2022 1:49:00 PM
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