- Li, Ang;
- Kuderer, Nicole M;
- Hsu, Chih‐Yuan;
- Shyr, Yu;
- Warner, Jeremy L;
- Shah, Dimpy P;
- Kumar, Vaibhav;
- Shah, Surbhi;
- Kulkarni, Amit A;
- Fu, Julie;
- Gulati, Shuchi;
- Zon, Rebecca L;
- Li, Monica;
- Desai, Aakash;
- Egan, Pamela C;
- Bakouny, Ziad;
- Devendra, KC;
- Hwang, Clara;
- Akpan, Imo J;
- McKay, Rana R;
- Girard, Jennifer;
- Schmidt, Andrew L;
- Halmos, Balazs;
- Thompson, Michael A;
- Patel, Jaymin M;
- Pennell, Nathan A;
- Peters, Solange;
- Elshoury, Amro;
- de Lima Lopes, Gilbero;
- Stover, Daniel G;
- Grivas, Petros;
- Rini, Brian I;
- Painter, Corrie A;
- Mishra, Sanjay;
- Connors, Jean M;
- Lyman, Gary H;
- Rosovsky, Rachel P;
- consortium, the CCC19
Background
Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking.Objectives
To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19.Methods
Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap.Results
From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission.Conclusions
Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population.