The CoVID‐TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID‐19

Abstract

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 ( C ancer subtype high to very‐high risk by o riginal Khorana score +1, V TE history +2, I CU admission +2, D ‐dimer elevation +1, recent systemic anti‐cancer T herapy +1, and non‐Hispanic E thnicity +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.

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

“…A total of 36 articles were included in the pooled analysis ( Table 1 ). 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 The majority (28; 78%) consisted of retrospective cohort studies whereas three (8%) were RCTs and five (14%) were prospective cohort studies ( Table 1 ).…”

3D-PAST: Risk Assessment Model for Predicting Venous Thromboembolism in COVID-19

“…Our model should assist clinicians in weighing the benefits of anticoagulation versus the risks of bleeding and help in deciding the initiation, and, more importantly, the continuation, of full-dose anticoagulation in the setting of increasing oxygen requirement. To the best of our knowledge, this is the first risk assessment scoring model dedicated to the inpatient COVID-19 population, with one prior model built for the cancer population admitted with COVID-19, with no validation on a separate dataset of patients [ 18 ]. This, along with other VTE studies that have validated the pre-COVID RAMs, included patients only from the early phase of pandemic [ 19 , 20 , 21 ].…”

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

“…A large cancer and COVID-19 registry of 2804 patients found similar VTE rates in patients who had been hospitalised with cancer compared with reported rates in patients without cancer. 91 There are no specific data regarding the benefit and risk of different anticoagulants for the treatment or prevention of VTE in patients with cancer and with COVID-19. Available data in the general population are summarised in the appendix (pp 81–83) .…”