Similarities and perspectives on the two C’s—Cancer and COVID‐19

Abstract

COVID-19 continues to dominate the health-care burden in the twenty-first century.While health-care professionals around the world try their best to minimize the mortality from this pandemic, we also continue to battle the high mortality from different types of cancer. For the hemostasis and thrombosis specialist, these two conditions present some unusual similarities including the high rate of thrombosis and marked elevation of D-dimers. In this forum article, we discuss these similarities and provide some considerations for future research and therapeutic trials.

Lessons learnt from COVID‐19 coagulopathy

“…This has already been demonstrated in studies where the pulmonary thrombus load in COVID-19 patients (compared with non-COVID- 19) is lower with the distribution of the clots being more in the peripheral pulmonary arteries [11]. This is akin to the finding of incidental pulmonary thrombi in patients with cancers [12].…”

“… D‐dimers have consistently been shown to be a prognostic marker in COVID‐19 [19,20]. This predictive capacity is independent of the heightened thrombotic risk suggesting it may signify the inflammatory process which can generate D‐dimers from extravascular fibrinolysis [12,21]. D‐dimers also correlate with acute lung injury in COVID‐19; a complication which can increase the need for mechanical ventilation and mortality [22].…”

Thrombosis, cancer, and COVID-19

“…Coagulopathy and disorders of hemostasis are commonly associated with both cancer and coronavirus disease 2019 (COVID-19) infection; thus, cancer patients with COVID-19 have an accumulative risk for thrombosis. Cancer-associated thrombosis (CAT) and COVID-19 have unusual similarities: both result in a markedly elevated thrombosis risk, including multi-system thrombosis, exceptionally high D-dimer levels, and the failure of anticoagulation therapy in some cases [ 1 , 2 ] (Table 1 ). CAT and COVID-19 are associated with high morbidity and mortality rates.…”

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

“…It is well-established that cancer carries an intrinsic risk for thrombosis, which is heterogeneous across different malignancies (14). Intriguingly, the similarities between cancer and COVID-19 regarding their pro-thrombotic effect have been highlighted (15); however, whether there is an additive effect in the risk of thromboembolic events when a patient with cancer is infected with SARS-CoV-2 remains unclear (16). Hence, there are no particular recommendations for prophylactic anticoagulation in patients with cancer and COVID-19 in inpatient or outpatient settings (10).…”