Background: Thromboembolic events (TE) have been increasingly reported among patients with COVID-19, causing significant morbidity and mortality. Additionally, it has been established that patients with cancer are at an increased risk of venous thrombotic embolism (VTE), with the annual incidence of VTE being nearly five times higher than in the general population (0.5% compared with 0.1%). It is unclear whether the risk of TE events is amplified when patients with active cancer develop COVID-19, with varying reports in the literature so far.Our objective was to evaluate the incidence and effects of thromboembolic events in hospitalized patients with active cancer and COVID-19 within 90 days.
Methods: A retrospective cohort analysis of patients with a history of cancer hospitalized for COVID-19 at OSF St Francis Medical Center in Peoria, IL from March 2020 to December 2020. Patients with a diagnosis of cancer within the last year (those receiving treatment or in remission) were included. Descriptive statistics included mean with standard deviation for continuous variables and frequency with percentage for categorical variables. Logistic regression was conducted for mortality and ICU admission, and generalized linear model with Poisson distribution and log link was employed for length of stay.
Results: There were a total of 78 patients with a history of cancer hospitalized for COVID-19 that met inclusion criteria. Of the 78, 12 patients (15.38%) had new thromboembolic events within 90 days of diagnosis, out of which all 12 were within the first 30 days of diagnosis. There were 7 arterial events (8.9%) out of which 4 were stroke, 1 mesenteric ischemia and 2 NSTEMI/STEMI. Of the 5 venous TE events, 2 were PE and 3 were DVT. Mortality was higher in the group that had thromboembolic events, 75% in the TE group vs 31.8% in the non-TE group (p=0.002) after adjustment of other variables. The ICU admissions were higher in the TE group with 91.7% of the TE group admitted to the ICU while only 42.4% of the non-TE group required ICU care (p=0.000). The LOS was higher in the TE group vs non-TE group (14.0 vs 10.1, p 0.001) Out of 12 patients with TE events, 7 were on no anticoagulation, 4 were on prophylactic anticoagulation, 1 was on therapeutic anticoagulation. In the 66 non-TE group, 46 were on prophylactic anticoagulation and 20 were on therapeutic anticoagulation. There was no correlation with age, sex, race/ethnicity, smoking status or cancer status to development of TE.
Conclusions: Among cancer patients with COVID-19, a high rate of TEs was observed within the first 30 days of hospital admission, with increased rate of ICU admission, prolonged length of stay and worse mortality compared to patients who did not develop TEs. Incidence of TE was much lower in patients on therapeutic dose anticoagulation as compared to prophylactic dose anticoagulation.