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

Anticancer Res. 2022 Jul;42(7):3261-3274. doi: 10.21873/anticanres.15815.

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.

Publication types

  • Review

MeSH terms

  • 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

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • RNA, Viral