Thrombotic and Clinical Outcomes in Patients with Hematologic Malignancy and COVID-19

Abstract

Background : Venous thromboembolism (VTE) is a common complication in acute COVID-19 and those with hematologic malignancy (HM) may be at an even higher risk. We performed a retrospective analysis of patients with history of HM and acute COVID-19 to evaluate thrombotic and clinical outcomes. Methods : Patients with COVID-19 were identified by positive SARS-CoV-2 PCR test. Our primary endpoints were rate of VTE and CVA in patients with HM compared to the general population (GP). Secondary outcomes included composite thrombotic events (CVA + VTE), COVID-19 fatality, respiratory support, ICU admission rates, and length of ICU stay Results : 833 patients were evaluated, 709 in the GP cohort, 124 patients in the HM cohort. CVA was more prevalent in the HM cohort (5.4% vs. 1.6%, p = 0.011). Rates of VTE were numerically higher for the HM cohort (8.0% vs. 3.6%, p = 0.069). The composite thrombotic rate was increased in the HM cohort (13.4% vs 5.2%, p = 0.005). Patients with HM had a higher inpatient fatality rate (35.5% vs 11.3%, p < 0.001), required more respiratory support (74.6% vs 46.5%, p < 0.001) and had a higher rate of ICU admission (31.9% vs 12.1%, p = 0.001). Conclusion : Our data demonstrated an increased rate of composite thrombotic (CVA + VTE) outcomes, indicating HM patients with acute COVID-19 are at increased risk of thrombosis. Irrespective of disease status, HM patients also have significantly increased need for intensive care, respiratory support, and have higher fatality rates.

Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL

“…The published data by Chatzikonstantinou et al [12] reported the VTE rate of 6.2% in the study that included 941 CLL patients with COVID-19. The study of 124 patients with various hematological malignancies [18], of whom 21 were patients with CLL, reported the rate of VTE of 8%, while the rate of composite thrombotic events (arterial and venous) was 13.4%. Besides the limitation of small patient numbers, direct comparison of this study and ours is of questionable relevance because the higher rate of cumulative thrombotic events in the former could be due to inclusion of particular hematological malignancies with well-established higher risk for thrombosis (e.g., plasma cell dyscrasia and myeloproliferative neoplasms).…”

Managing and treating COVID-19 in patients with hematological malignancies: a narrative review and expert insights

“…It has been postulated that endothelial injury plays a central role in the pathogenesis of acute respiratory distress syndrome and organ failure in severe COVID-19 [ 26 ]. Moreover, COVID-19 is associated with complex coagulation abnormalities, leading to a hypercoagulable state and thrombosis [ 26 , 27 ]. Stasis, common in hospitalized or critically ill patients, irrespective of COVID-19, is a well-known contributor to the development of venous thromboembolism (VTE) [ 27 ].…”

“…Moreover, COVID-19 is associated with complex coagulation abnormalities, leading to a hypercoagulable state and thrombosis [ 26 , 27 ]. Stasis, common in hospitalized or critically ill patients, irrespective of COVID-19, is a well-known contributor to the development of venous thromboembolism (VTE) [ 27 ]. Patients with COVID-19 exhibit various prothrombotic factors, including elevated factor VIII, as well as laboratory abnormalities indicating increased fibrinogen and D-dimer levels [ 27 ].…”

“…Stasis, common in hospitalized or critically ill patients, irrespective of COVID-19, is a well-known contributor to the development of venous thromboembolism (VTE) [ 27 ]. Patients with COVID-19 exhibit various prothrombotic factors, including elevated factor VIII, as well as laboratory abnormalities indicating increased fibrinogen and D-dimer levels [ 27 ]. This phenotypic hypercoagulable state has been referred to as "COVID-19-associated coagulopathy or thromboinflammation" [ 28 ].…”

“…This phenotypic hypercoagulable state has been referred to as "COVID-19-associated coagulopathy or thromboinflammation" [ 28 ]. In parallel, cancer itself is associated with a hypercoagulable state and a significantly higher incidence of thromboembolic complications [ 26 , 27 ]. Therefore, the combination of HM and COVID-19 may amplify this risk, resulting in overall poor outcomes [ 26 , 27 ].…”