Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL

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Title: Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL
Authors: Antic, Darko
Milic, Natasa
Chatzikonstantinou, Thomas
Scarfò, Lydia
Otasevic, Vladimir
Rajovic, Nina
Allsup, David
Alonso Cabrero, Alejandro
Andres, Martin
Baile Gonzales, Monica
Capasso, Antonella
Collado, Rosa
Cordoba, Raul
Cuéllar-García, Carolina
Correa, Juan G.
De Paoli, Lorenzo
De Paolis, Maria R.
Del Poeta, Giovanni
Dimou, Maria
Doubek, Michael
Efstathopoulou, Maria
El-Ashwah, Shaimaa
Enrico, Alicia
Espinet, Blanca
Farina, Lucia
Ferrari, Angela
Foglietta, Myriam
Lopez-Garcia, Alberto
García-Marco, José A.
García-Serra, Rocío
Gentile, Massimo
Gimeno, Eva
da Silva, Maria G.
Gutwein, Odit
Hakobyan, Yervand K.
Herishanu, Yair
Hernández-Rivas, José Á.
Herold, Tobias
Itchaki, Gilad
Jaksic, Ozren
Janssens, Ann
Kalashnikova, Olga B.
Kalicińska, Elżbieta
Kater, Arnon P.
Kersting, Sabina
Koren-Michowitz, Maya
Labrador, Jorge
Lad, Deepesh
Laurenti, Luca
Fresa, Alberto
Levin, Mark-David
Mayor Bastida, Carlota
Malerba, Lara
Marasca, Roberto
Marchetti, Monia
Marquet, Juan
Mihaljevic, Biljana
Milosevic, Ivana
Mirás, Fatima
Morawska, Marta
Motta, Marina
Munir, Talha
Murru, Roberta
Nunes, Raquel
Olivieri, Jacopo
Pavlovsky, Miguel A.
Piskunova, Inga
Popov, Viola M.
Quaglia, Francesca M.
Quaresmini, Giulia
Reda, Gianluigi
Rigolin, Gian M.
Shrestha, Amit
Šimkovič, Martin
Smirnova, Svetlana
Špaček, Martin
Sportoletti, Paolo
Stanca, Oana
Stavroyianni, Niki
Te Raa, Doreen
Tomic, Kristina
Tonino, Sanne
Trentin, Livio
Van Der Spek, Ellen
van Gelder, Michel
Varettoni, Marzia
Visentin, Andrea
Vitale, Candida
Vukovic, Vojin
Wasik-Szczepanek, Ewa
Wróbel, Tomasz
Segundo, Lucrecia Y. S.
Yassin, Mohamed
Coscia, Marta
Rambaldi, Alessandro
Montserrat, Emili
Foà, Robin
Cuneo, Antonio
Carrier, Marc
Ghia, Paolo
Stamatopoulos, Kostas
Date: 2022-08-26
Abstract: Abstract Background Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19. Methods This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting. Results A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017–1.109 and OR = 2.438, 95%CI 1.023–5.813, respectively). Conclusions Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.
URL: https://doi.org/10.1186/s13045-022-01333-0
http://hdl.handle.net/10393/43978
CollectionPublications par les auteurs d'uOttawa publiés par BioMed Central // uOttawa authored publications from BioMed Central
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