ABSTRACT
Background and ImportanceIn Europe, the VITAE study estimates an annual incidence of venous thromboembolic disease (VTD) of 243/100,000 inhabitants.About 25% of VTD cases are related to hospital admissions and 50–75% of VTD cases occur in non-surgical hospitalised patients. PRETEMED is a validated thrombotic risk (TR) scale for clinical prediction that have been designed to be used in daily clinical practice. As well, it is recommended to assess the bleeding risk (BR) with another validated scale called IMPROVE scale before starting thromboprophylaxis (TP).Aim and ObjectivesDetermine the (TR/BR) and analyse whether the prescription of thromboprophylaxis in patients from the Emergency Department who are going to be admitted to the hospital ward is adequate.Material and MethodsProspective observational cohort study, carried out in a 2nd level hospital during a period of 10 days. Adult patients in the ED awaiting admission to the hospital ward were included.Patients with therapeutic effort limitation, COVID-19 patients, those who had been transfused in the last 48 hours, bleeding patients or those with underlying pathology that require anticoagulation were excluded. Using the PRETEMED/IMPROVE scales, the TR/BR was determined, as well as the indication of thromboprophylaxis.Results62 patients. 31 women (50%). The median age [range] was 71 [18–93] years. 31 patients with TP regimen, no interventions had to be performed, they had an adequate indication with PRETEMED> 4 and IMPROVE <7. 31 patients without TP regimen;7 (23%) of them had indication for TP and they went into the operating room with PRETEMED> 4 and IMPROVE <7. 7 (11.3%) of the patients required pharmaceutical intervention to adequate their TP, all of them by default.Conclusion and RelevanceThe prescription of TP in adults who visit the ED could be considered adequate in a high percentage, however it can be optimised according to the PRETEMED and IMPROVE guidelines. It is essential to recommend on the use of scales that assess TR/BR for the correct decision-making in the prescription of TP. The limitation of the study was the small sample size.References and/or AcknowledgementsConflict of InterestNo conflict of interest
ABSTRACT
Background: ICI are widely used in the treatment of various cancer types. It has been hypothesized that ICI couldconfer an increased risk of severe acute lung injury or other complications associated with severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2). Methods: We analyzed data from 113 patients with laboratory-confirmed COVID-19 while on treatment with ICI without chemotherapy in 19 hospitals in North America, Europe, and Australia. Data collected included details onsymptoms, comorbidities, medications, treatments and investigations for COVID-19, and outcomes (hospitaladmission, ICU admission, and mortality). Results: The median age was 63 years (range 27-86);40 (35%) patients were female. Most common malignancies were melanoma (n=64, 57%), non-small cell lung cancer (n=19, 17%), and renal cell carcinoma (n=11, 10%);30(27%) patients were treated for early (neoadjuvant/adjuvant) and 83 (73%) for advanced cancer. Most patientsreceived anti-PD-1 (n=85, 75%), combination anti-PD-1 and anti-CTLA-4 (n=15, 13%), or anti-PD-L1 (n=8, 7%) ICI.Comorbidities included cardiovascular disease (n=31, 27%), diabetes (n=17, 15%), and pulmonary disease (n=14, 12%). Symptoms were present in 68 (60%) patients;46 (68%) had fever, 40 (59%) cough, and 23 (34%) dyspnea.Overall, ICI was interrupted in 58 (51%) patients. At data cutoff, 33 (29%) patients were admitted to hospital, 6 (5%)to ICU, and 9 (8%) patients died. COVID-19 was the primary cause of death in 7 patients, 3 of whom were admittedto ICU. Cancer types in patients who died were melanoma (2), non-small cell lung cancer (2), renal cell carcinoma(2), and others (3);all (9) patients had advanced cancer. Administered treatments were oxygen therapy (8), mechanical ventilation (2), vasopression (2), antibiotics (7), antiviral drugs (4), glucocorticoids (2), and anti-IL-6 (2).Of all hospitalized patients, 20 (61%) had been discharged and 4 (12%) were still in hospital at data cutoff. Conclusion: The mortality rate of COVID-19 in patients on ICI is higher than rates reported for the generalpopulation without comorbidities but may not be higher than rates reported for the cancer population. Despite thesepreliminary findings, COVID-19 patients on ICI may not have symptoms and a proportion may continue ICI.Correlative analyses are ongoing and will be presented.