Venous Thromboembolism Incidence Low in Pediatric Cancer Patients with COVID-19

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Pediatric cancer patients with COVID-19 had a lower incidence of venous thromboembolism (VTE) than patients without COVID-19, according to new research.¹

Previous studies found adult patients with COVID-19 are at an increased risk of VTE—and have an increased risk of mortality due to VTE-linked complications. A 2021 meta-analysis demonstrated a high incidence of pulmonary embolism, deep vein thrombosis and VTE in patients who required ICU care for COVID-19.² Moreover, in an earlier 2020 systematic literature search study, the investigators found 86 studies reporting VTE rates in 33,970 COVID-19 patients.³

Furthermore, cancer increases the risk of VTE as well to a four-fold.¹ Patients who receive active chemotherapy have a risk of VTE up to 6.5 times.

Yet not many studies have evaluated VTE cases among pediatric patients with COVID-19. According to a new study presented at the American Society of Hematology (ASH) 2023 Annual Meeting, the incidence of VTE in children is very low but is higher in hospitalized children.⁴ If children have VTE, it is a severe issue due to the potential for associated mortality, significant complications like pulmonary embolism, cerebrovascular events, and thrombotic syndrome.

A new retrospective analysis, led by Shaikha Alqahtani, MD, from the division of pediatrics at The University of Texas in Houston, sought to determine the incidence of VTE in pediatric cancer patients with COVID-19.¹ The study also explored COVID-19-associated complications and comorbidities in pediatric cancer patients. Alqahtani presented his team’s study on December 9, 2023, at ASH 2023.

Alqahtani and colleagues selected participants from the MD Anderson Cancer Center’s COVID-19 database, created at the beginning of the pandemic. Participants were included if they visited the MD Anderson Cancer Center from March 2020 – March 2023, were aged 0 – 18 years old, got infected by COVID-19, and had thrombosis develop either 14 days prior or 3 months after the COVID-19 infection. People in the study could have any type of cancer.

The study included 3 cohorts. Group 1 included patients with COVID-19 with or without VTE and had 235 cancer patients, with half male (50%), 57.4% Caucasians, and the mean age 11.1 years old. Group 2 had 272 patients with VTE with or without COVID-19—with 55% male, 54% Caucasian, and mean age 13.1. Then, with group 3, patients had COVID-19 and VTE simultaneously—the team only identified 3 patients for this cohort.

“The incidence of VTE in pediatric cancer patients affected by COVID-19 infection was lower compared to COVID-19 negative pediatric cancer patients,” the investigators wrote. “Our findings suggest that COVID-19 infection does not appear to be an additional risk factor for the development of VTE in pediatric cancer patients.”

^References

1. ^{Alqahtani, S, Munir, F, Ramsey, L, et al. 1264 Incidence of Venous Thromboembolism in Pediatric Cancer Patients with COVID-19: MD Anderson Cancer Center Experience. American Society of Hematology. December 9, 2023. https://ash.confex.com/ash/2023/webprogram/Paper188023.html. Accessed December 5, 2023.}
2. ^{Iapoce, C. High Incidence of VTE Observed in ICU Hospitalizations for COVID-19. HCPLive. September 27, 2021. https://www.hcplive.com/view/high-incidence-vte-observed-icu-hospitalizations-covid-19. Accessed December 5, 2023.}
3. ^{Walter, K. Researchers Explore Venous Thromboembolism Rates in COVID-19 Patients. HCPLive. October 2, 2020. https://www.hcplive.com/view/venous-thromboembolism-covid-19. Accessed December 5, 2023.}
4. ^{ASH VTE Guidelines: Pediatrics. American Society of Hematology. https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/venous-thromboembolism-guidelines/pediatrics#:~:text=The%20incidence%20of%20VTE%20in,well%20as%20post%2Dthrombotic%20syndrome. Accessed December 5, 2023.}