Abstract 445: Natural history of coagulopathy in patients with cancer infected with COVID19: A real-world data (RWD) analysis

Abstract

Abstract Background and Objective: Studies of hospitalized patients (pts) with COVID19 indicate that arterial or venous thrombotic complications occur in up to half of pts. Risk of these severe complications in pts with cancer is unknown. We estimated the incidence of arterial thrombosis (AT) and venous thromboembolism (VT) using RWD from pts with active or history of cancer with COVID19. Methods: Adult pts with cancer receiving treatment in community health systems, with COVID19 identified via ICD code or lab confirmation in 2020, were reviewed for incident AT and VT in a 90 day window following COVID19 diagnosis (index). AT was acute myocardial infarction (MI) or acute ischemic or embolic stroke (S). VT was acute deep venous thrombosis (DVT) or acute pulmonary embolism (PE). Medication use (anticoagulant, antiplatelet, statin) and comorbidities were assessed 6 months and 1 year prior to index, respectively. Results: Median age of 7,591 pts with cancer and COVID19 was 67 years and median follow up was 90 days. 32% of pts were hospitalized within 14 days, 2% received ventilator support, 6% had cardiovascular disease (CVD) and 1% had prior VT. Absolute risk of VT was significantly higher than AT (3% vs. 2%, chi square p= < 0.001), with 161 pts experiencing AT [81 (1%) MI; 80 (1%) S] and 240 pts experiencing VT [99 (1%) DVT; 158 (2%) PE]. This trend held across most subgroups (Table 1). The incidence rate per person-year was 0.094 for AT (0.047 MI, 0.046 S) and 0.141 for VT (0.058 DVT, 0.092 PE). CoxPH models did not show age, sex, comorbidities or medication use as significantly associated with higher probability of AT or VT. Conclusions: RWD showed pts with cancer and COVID19 were at higher risk for VT than AT. Pts who received ventilator support, or had prior VT or prior CVD had highest risk for these events. Severity of these outcomes emphasizes the need for risk reducing interventions. Acknowledgement of Reagan-Udall Foundation and Friends of Cancer Research COVID19 Evidence Accelerator. Table 1. Incidence of arterial and venous events stratified by baseline characteristics at COVID-19 diagnosis among n= 7,591 patients with cancer and infected with COVID19 Absolute Risk, N(%) Incidence Rate Total, N Arterial thrombosis Venous thromboembolism Chi square p-value Arterial thrombosis Venous thromboembolism p-value All 7,591 160 (2.1) 240 (3.2) <0.001 0.0935 0.1414 <0.001 Age 18-44 669 10 (1.5) 10 (1.5) 0.008 0.012 0.061 0.020 45-54 922 4 (0.4) 18 (2) 0.018 0.08 0.003 55-64 1751 26 (1.5) 54 (3.1) 0.062 0.129 0.001 65-74 2054 49 (2.4) 78 (3.8) 0.104 0.165 0.008 75-84 1506 55 (3.7) 60 (4) 0.169 0.184 0.557 85+ 689 24 (3.5) 20 (2.9) 0.18 0.15 0.542 Sex Female 4142 75 (1.8) 126 (3) 0.338 0.078 0.131 0.000 Male 3449 85 (2.5) 114 (3.3) 0.11 0.148 0.030 Race Black 1437 31 (2.2) 61 (4.2) 0.215 0.095 0.187 0.001 White 5054 113 (2.2) 157 (3.1) 0.098 0.137 0.003 Other/Unknown 1100 16 (1.5) 22 (2) 0.061 0.084 0.724 Severity of infection at diagnosis Not hospitalized 5815 78 (1.3) 141 (2.4) 0.0676 0.06 0.105 <0.001 Hospitalized, no ventilator support 1710 76 (4.4) 92 (5.4) 0.21 0.261 0.143 Hospitalized with ventilator support 106 6 (9.1) 7 (10.6) 0.326 0.326 0.965 Existing Cardiovascular disease Yes 467 94 (20.2) 23 (4.9) <0.001 0.105 0.06 <0.001 No 7124 66 (0.9) 217 (3) 0.21 0.261 <0.001 And baseline anticoagulant use 122 27 (22.1) 9 (7.4) <0.001 0.326 0.326 0.602 And no baseline anticoagulant use 7469 67 (19.5) 14 (4.1) 0.088 0.054 <0.001 Previous Venous thromboembolism Yes 312 12 (3.8) 64 (20.5) <0.001 0.184 0.981 <0.001 No 7279 148 (2.0) 176 (2.3) 0.089 0.105 0.542 And baseline anticoagulant use 121 9 (4.7) 22 (11.6) 0.273 0.397 0.969 <0.001 And no baseline anticoagulant use 7470 3 (1.6) 42 (22.1) 0.088 0.127 0.003 Existing Thrombocytosis (via ICD or platelet count >450 x 10^9/L) Yes 185 5 (2.7) 7 (3.8) 1 0.123 0.172 0.087 No 7406 155 (2.1) 233 (3.1) 0.091 0.137 <0.001 Citation Format: Jeanna Wallenta Law, Danny Idyro, Andrew Schrag, Frank Wolf, Thomas D. Brown. Natural history of coagulopathy in patients with cancer infected with COVID19: A real-world data (RWD) analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 445.