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COVID-19 impact on thrombotic complications in cancer patients

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.519

Abstract

Aim: to study the features of thrombotic complications in cancer patients during COVID-19 infection, and identify the most significant diagnostic and prognostic criteria.

Materials and Methods. Within the framework of cohort non-randomized study, there were analyzed the course of coronavirus infection in 72 hospitalized patients with uterine cancer (n = 22), cervical cancer (n = 19), ovarian cancer (n = 24) as well as vaginal and vulvar cancer (n = 7). All patients hospitalized for COVID-19 were examined and treated in accordance with the Interim guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” effective at the time of therapy. Additionally, on days 3–7 after hospitalization, a blood test was performed once to determine the level of metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), ADAMTS-13 activity, ADAMTS-13 inhibitor and von Willebrand factor (vWF) level.

Results. It was shown that the average age of the patients was 56.96 ± 7.55 years, the length of hospitalization ranged from 7 to 19 (13.0 ± 3.79) days. The disease severity was assessed by the degree of lung tissue damage based on computed tomography (CT), respiratory failure and development of systemic inflammatory response syndrome (SIRS). During hospitalization, CT-2 was detected in 46 (63.9 %) patients, CT-3 – in 26 (36.1 %) patients; 37 (51.4 %) patients were transferred to the intensive care unit (ICU). Clinically significant deep vein thrombosis (DVT) was diagnosed in 9 (12.5 %) patients, and pulmonary embolism (PE) – in 4 (5.6 %) patients. Of these, 6 cases of DVT and 3 cases of PE were fatal. A total of 14 (19.44 %) patients deceased due to developing acute cardiopulmonary failure. A vWF/ADAMTS-13 ratio greater than 2.1 was found in all ICU patients. Despite anticoagulant therapy, patients with DVT and PE had this ratio higher than 3.3 (4.00 ± 0.48), whereas in all 14 deceased patients it exceeded 2.98.

Conclusion. Venous thromboembolism, including PE and DVT, has been identified as а serious complication of COVID-19. An opportunity to predict them early is of special importance because they may lead to serious complications such as disseminated intravascular coagulation, SIRS, cardiopulmonary failure, and death. In patients suffering from cancer infected with COVID-19, not only a decline in ADAMTS-13 activity and level was detected, but also a parallel increase in vWF level. A vWF/ADAMTS-13 ratio may be an early indicator of COVID-19 severity in such patients: a vWF/ADAMTS-13 ratio exceeding 2.1 was common for all ICU patients. Hence, it evidences about a potential for using this parameter to early identify such risk patients who may require more intensive care and medical intervention.

About the Authors

A. V. Vorobev
Sechenov University
Russian Federation

Alexander V. Vorobev – MD, PhD, Associate Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 57191966265.

Researcher ID: F-8804-2017.

8 bldg. 2, Trubetskaya Str., Moscow 119991


S. E. Einullaeva
Sechenov University
Russian Federation

Sabina E. Einullaeva – 6th year Student

8 bldg. 2, Trubetskaya Str., Moscow 119991


A. S. Borodulin
Sechenov University
Russian Federation

Aleksandr S. Borodulin – 6th year Student

8 bldg. 2, Trubetskaya Str., Moscow 119991


M. A. Shikina
Sechenov University
Russian Federation

Mariia A. Shikina – 6th year Student

8 bldg. 2, Trubetskaya Str., Moscow 119991


S. A. Aliev
Sechenov University
Russian Federation

Said A. Aliev – 6th year Student

8 bldg. 2, Trubetskaya Str., Moscow 119991


A. G. Solopova
Sechenov University
Russian Federation

Antonina G. Solopova – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children's Health

Scopus Author ID: 6505479504.

Researcher ID: Q-1385-2015.

8 bldg. 2, Trubetskaya Str., Moscow 119991


V. N. Galkin
Yudin City Clinical Hospital, Moscow Healthcare Department
Russian Federation

Vsevolod N. Galkin – MD, Dr Sci Med, Professor, Chief Physician

18А bldg. 7, Zagorodnoye Shosse, Moscow 117152


A. E. Ivanov
Yudin City Clinical Hospital, Moscow Healthcare Department
Russian Federation

lexander E. Ivanov – MD, PhD, Head of the Department of Diagnostics and Treatment of Breast and Reproductive System Diseases No. 1

18А bldg. 7, Zagorodnoye Shosse, Moscow 117152


V. O. Bitsadze
Sechenov University
Russian Federation

Victoria O. Bitsadze – MD, Dr Sci Med, Professor of RAS, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 6506003478.

Researcher ID: F-8409-2017.

8 bldg. 2, Trubetskaya Str., Moscow 119991


J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health

Scopus Author ID: 57194547147.

Researcher ID: F-8384-2017.

8 bldg. 2, Trubetskaya Str., Moscow 119991


D. V. Blinov
Sechenov University; Institute for Preventive and Social Medicine; Moscow Haass Medical – Social Institute
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Assistant, Department of Sports Medicine and Medical Rehabilitation, Sklifosovsky Institute of Clinical Medicine, Sechenov University; Head of Medical and Scientific Affairs, Institute for Preventive and Social Medicine; Associate Professor, Department of Sports, Physical and Rehabilitation Medicine, Moscow Haass Medical – Social Institute

Scopus Author ID: 6701744871.

Researcher ID: E-8906-2017. RSCI: 9779-8290.

8 bldg. 2, Trubetskaya Str., Moscow 119991;
4–10 Sadovaya-Triumfalnaya Str., Moscow 127006;
5 bldg. 1–1a, 2-ya Brestskaya Str., Moscow 123056


J.-C. Gris
Sechenov University; University of Montpellier
Russian Federation

Jean-Christophe Gris – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health, Sechenov University; Professor of Haematology, Head of the Laboratory of Haematology, Faculty of Biological and Pharmaceutical Sciences, Montpellier University and University Hospital of Nîmes, France; Foreign Member of RAS

Scopus Author ID: 7005114260.

Researcher ID: AAA-2923-2019.

8 bldg. 2, Trubetskaya Str., Moscow 119991;
163 Rue Auguste Broussonnet, Montpellier 34090, France


I. Elalamy
Sechenov University; Medicine Sorbonne University; Hospital Tenon
Russian Federation

Ismail Elalamy – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health, Sechenov University; Professor, Medicine Sorbonne University; Director of Hematology, Department of Thrombosis Center, Hospital Tenon

Scopus Author ID: 7003652413.

Researcher ID: AAC-9695-2019.

8 bldg. 2, Trubetskaya Str., Moscow 119991;
12 Rue de l’École de Médecine, Paris 75006, France;
4 Rue de la Chine, Paris 75020, France


A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya – MD, Dr Sci Med, Academician of RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatal Medicine, Filatov Clinical Institute of Children’s Health, Sechenov University; Vice-President of the Russian Society of Obstetricians and Gynecologists (RSOG); Honorary Doctor of the Russian Federation; Emeritus Professor of the University of Vienna

Scopus Author ID: 57222220144.

Researcher ID: M-5660-2016.

8 bldg. 2, Trubetskaya Str., Moscow 119991


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What is already known about this subject?

► COVID-19 and cancer are associated with a higher risk of thrombotic complications that further potentiates upon their combination.

► Both conditions cause hypercoagulability and increased thrombogenicity.

► Anticoagulant therapy is effective in lowering thrombotic risk.

What are the new findings?

► Cancer patients with COVID-19 experience elevated von Willebrand factor (vWF) level and metalloproteinase ADAMTS-13 deficiency.

► An early severity criterion in this case may be proposed as a vWF/ADAMTS-13 ratio exceeding 2.1.

► A prominent rise in ADAMTS-13 inhibitor level was observed in Intensive Care Unit (ICU) patients, especially in non-survi-
vors being a sign for progression of systemic inflammatory response syndrome, despite of anti-inflammatory therapy.

How might it impact on clinical practice in the foreseeable future?

► The study provides deeper insight into the impact of COVID-19 on cancer patients, which may influence treatment strategies in this patient group.

► Assessing vWF/ADAMTS-13 ratio as an early indicator of disease severity can assist in early diagnostics of thrombotic complications and potentially life-threatening conditions.

► The study data highlight a need for continuing investigations to propose more precise treatment protocols and predict a risk of thrombosis in cancer patients with COVID-19.

Review

For citations:

Vorobev A.V., Einullaeva S.E., Borodulin A.S., Shikina M.A., Aliev S.A., Solopova A.G., Galkin V.N., Ivanov A.E., Bitsadze V.O., Khizroeva J.Kh., Blinov D.V., Gris J., Elalamy I., Makatsariya A.D. COVID-19 impact on thrombotic complications in cancer patients. Obstetrics, Gynecology and Reproduction. 2024;18(3):286-299. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.519

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