Prominent Hypercoagulability Associated With Inflammatory State Among Cancer Patients With SARS-CoV-2 Infection

Abstract

Abnormal coagulation parameters and potential benefits of anticoagulant therapy in general population with novel coronavirus pneumonia (COVID-19) have been reported. However, limited data are available on cancer patients. Coagulation indexes and inflammation parameters in 57 cancer patients with SARS-CoV-2 infection with different severity were retrospectively analyzed. We found that D-dimer levels were increased in 33 patients (57.9%, median: 790 ng/mL). Compared with ordinary type patients, severe and critical ill patients had decreased MPV values (P = 0.006), prolonged PT (median: 13.3 vs. 11.5 vs. 11.4 s, P < 0.001), significant higher D-dimer levels (median: 2,400 vs. 940 vs. 280 ng/mL, P < 0.001), higher PCT levels (median: 0.17 vs. 0.055 vs. 0.045 ng/mL, P = 0.002), higher IL-6 (median: 20.6 vs. 2.3 vs. 3.0 pg/mL, P = 0.040), and decreased PaO₂ (median: 68 vs. 84 vs. 96 mm Hg, P < 0.001). Importantly, three patients, one severe and two critical ill type, with increased D-dimer survived after anticoagulant therapy with continuous heparin infusion. Increased D-dimer levels positively correlated with increased PCT levels (r = 0.456, P = 0.002) and IL-6 levels (r = 0.501, P = 0.045). A negative correlation between D-dimer levels and PaO₂ levels (r = -0.654, P = 0.021) were also existed. Cancer patients with COVID-19 showed prominent hypercoagulability associated with severe inflammation, anticoagulation therapy might be useful to improve the prognosis and should be immediately used after the onset of hypercoagulability.

Keywords: COVID-19; D-dimer; SARS-CoV-2; cancer; hypercoagulability.

Figure 1

Changes in coagulation indexes, platelet parameters, chest CT, and X-ray images in Patient 1. (A) Changes in coagulation indexes and platelet parameters showed a decrease in D-dimer levels after heparin treatment. (B) Chest CT and X-ray images showed improvement in the multiple, bilateral, ground-glass opacities.

Figure 2

Changes in coagulation indexes, platelet parameters, and chest CT scans in Patient 2. (A) Changes in coagulation indexes and platelet parameters showed an initial increase followed by a decrease in D-dimer levels after heparin treatment. (B) Chest CT scans showed improvement in the bilateral, ground-glass opacities.

Figure 3

Changes in coagulation indexes, platelet parameters and chest CT scans in Patient 3. (A) Changes in coagulation indexes and platelet parameters showed a decrease in D-dimer levels after using heparin but a rebound after its withdrawal. (B) CT scans showed significant improvement in the bilateral, ground-glass opacities but persistent hydrothorax on the right.