The CoVID- TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID- 19
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; Kc, Devendra; 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; 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.
2021-10
Citation
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; Kc, Devendra ; 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; 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. (2021). "The CoVID- TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID- 19." Journal of Thrombosis and Haemostasis (10): 2522-2532.
Abstract
BackgroundHospitalized 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.ObjectivesTo assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID- 19.MethodsAmong 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.ResultsFrom 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.ConclusionsHospitalized 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.Publisher
Wiley Periodicals, Inc.
ISSN
1538-7933 1538-7836
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