Incidence of thrombosis and hemorrhage in hospitalized cancer patients with COVID-19

Abstract

Background: Coronavirus disease-2019 (COVID-19) is a recognized prothrombotic state. Patients hospitalized with active cancer are predisposed to thrombosis but whether active cancer further amplifies thrombotic risk with COVID-19 is not known.

Objectives: To evaluate cumulative incidences of thrombotic and hemorrhagic events in hospitalized COVID-19 patients with and without active cancer at 28 days.

Methods: A retrospective cohort analysis of consecutive adults hospitalized with COVID-19 was performed. Active cancer required cancer-directed therapy within previous 6 months. The cumulative incidences of thrombosis or hemorrhage were estimated considering death as a competing risk.

Results: Patients without cancer (n = 353) and active cancer (n = 45) were comparable in terms of age, sex, antibiotics administered, length of hospitalization, and critical care. The most common malignancies were lymphoid (17.8%), gastrointestinal (15.6%), lung (13.3%), and genitourinary (13.3%). At day 28, the cumulative incidence of thrombotic events was 18.2% (95% confidence interval [CI], 10.2%-27.9%) in the non-cancer cohort and 14.2% (95% CI, 4.7%-28.7%) in the cancer cohort. The cumulative incidence of major and fatal bleeding at day 28 was 20.8% (95% CI, 12.1%-31.0%) in the non-cancer group and 19.5% (95% CI, 5.5%-39.8%) in the cancer cohort. Three patients experienced fatal bleeds, all of whom were in the non-cancer cohort. Survival was significantly shorter in the group with active cancer (P = .038).

Conclusions: We observed a similarly high incidence of thrombosis and bleeding among patients admitted with COVID-19 with or without active cancer.

Keywords: COVID-19; anticoagulation; cancer; hemorrhage; venous thromboembolism.

FIGURE 1

Cumulative incidence of thrombosis. A, Cumulative incidence of all thrombotic events with death as a competing risk. B, Cumulative incidence of major thrombosis, including pulmonary embolism, proximal deep vein thrombosis, upper extremity thrombosis, and arterial events. Red depicts events in active cancer cohort and blue the cohort without cancer

FIGURE 2

Cumulative incidence of hemorrhage. A, Cumulative incidence of major and fatal hemorrhagic events with death as a competing risk. B, Cumulative incidence of the composite of hemorrhage including major or fatal as well as clinically relevant non‐major bleeding. Red depicts events in active cancer and blue patients without cancer

FIGURE 3

Survival comparison for patients with COVID‐19 with and without active cancer. Figure shows the Kaplan‐Meier survival estimates for hospitalized patients with COVID‐19, with active cancer (red) and without cancer (blue)