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Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL
D. Antic, N. Milic, T. Chatzikonstantinou, L. Scarfò, V. Otasevic, N. Rajovic, D. Allsup, A. Alonso Cabrero, M. Andres, M. Baile Gonzales, A. Capasso, R. Collado, R. Cordoba, C. Cuéllar-García, JG. Correa, L. De Paoli, MR. De Paolis, G. Del...
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, multicentrická studie
NLK
BioMedCentral
od 2008-12-01
BioMedCentral Open Access
od 2008
Directory of Open Access Journals
od 2008
Free Medical Journals
od 2008
PubMed Central
od 2008
Europe PubMed Central
od 2008
ProQuest Central
od 2009-01-01
Open Access Digital Library
od 2008-01-01
Open Access Digital Library
od 2008-01-01
Medline Complete (EBSCOhost)
od 2009-01-17
Health & Medicine (ProQuest)
od 2009-01-01
ROAD: Directory of Open Access Scholarly Resources
od 2008
Springer Nature OA/Free Journals
od 2008-12-01
- MeSH
- antikoagulancia MeSH
- chronická lymfatická leukemie * MeSH
- COVID-19 * MeSH
- farmakoterapie COVID-19 MeSH
- heparin nízkomolekulární MeSH
- krvácení MeSH
- lidé MeSH
- SARS-CoV-2 MeSH
- senioři MeSH
- testování na COVID-19 MeSH
- trombóza * MeSH
- žilní tromboembolie * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
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.
Centre for Atherothrombosis and Metabolic Disease Hull York Medical School Hull UK
Clinical Centre of Vojvodina Faculty of Medicine University of Novi Sad Novi Sad Serbia
Consultant Haematologist St James's Hospital Leeds LS9 7TF UK
Department Hematooncology and Bone Marrow Transplantation Medical University in Lublin Lublin Poland
Department Internal Medicine Maastricht University Medical Center Maastricht The Netherlands
Department of Biomedicine and Prevention Hematology University Tor Vergata Rome Italy
Department of Haematology Athens Medical Center Psychikon Branch Athens Greece
Department of Hematology Gelderse Vallei Ede Ede The Netherlands
Department of Hematology Haga Teaching Hospital The Hague The Netherlands
Department of Hematology Hospital del Mar Barcelona Spain
Department of Hematology Hospital General Universitario Valencia Spain
Department of Hematology Infanta Leonor University Hospital Madrid Spain
Department of Hematology Shamir Medical Center Zerifin Israel
Department of Hematology Universitaire Ziekenhuizen Leuven Leuven Belgium
Department of Hematology University Hospital Dubrava Zagreb Croatia
Department of Internal Medicine Albert Schweitzer Hospital Dordrecht The Netherlands
Department of Internal Medicine Hematology and Oncology University Hospital Brno Czechia
Department of Internal Medicine Rijnstate Hospital Arnhem The Netherlands
Department of Medical Genetics and Genomics Faculty of Medicine Masaryk University Brno Czechia
Department of Medicine Section of Hematology University of Verona Verona Italy
Division of Hematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
Division of Internal Medicine Hematology Unit ASL Vercelli Vercelli Italy
Experimental Hematooncology Department Medical University of Lublin Lublin Poland
Faculty of Medicine University of Belgrade Belgrade Serbia
Fundación de Investigación del Hospital General Universitario Valencia Spain
FUNDALEU Clinical Research Center Buenos Aires Buenos Aires Argentina
Haematology Department Hospital Universitario de La Princesa Madrid Spain
Hematology and Clinical Immunology Unit Department of Medicine University of Padova Padua Italy
Hematology and Stem Cell Transplant Center Marche Nord Hospital Pesaro Italy
Hematology ASST Papa Giovanni XXIII Bergamo Italy
Hematology Center after Prof Yeolyan MH RA Yerevan Armenia
Hematology Clinic ASUFC Udine Italy
Hematology Department and HCT Unit G Papanicolaou Hospital Thessaloniki Greece
Hematology Department Colentina Clinical Hospital Bucharest Romania
Hematology Department Hospital Universitario 12de Octubre Madrid Spain
Hematology Department Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain
Hematology Department of Translational and Precision Medicine Sapienza University Rome Italy
Hematology Department Portuguese Institute of Oncology Lisbon Lisbon Portugal
Hematology Department Ramón y Cajal University Hospital Madrid Spain
Hematology Department St John's Cancer Center Lublin Poland
Hematology Department Unit Research Complejo Asistencial Universitario de Burgos Burgos Spain
Hematology Department University Hospital of Salamanca IBSAL Salamanca Spain
Hematology Fondazione IRCCS Istituto Nazionale Tumori Milan Italy
Hematology Unit and TMO Center AO SS Antonio e Biagio e Cesare Arrigo Alessandria Italy
Hematology Unit AO Cosenza Cosenza Italy
Hematology Unit Azienda Unità Sanitaria Locale IRCCS Reggio Emilia Italy
Hematology Unit Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan Milan Italy
Hematology Unit Nepal Cancer Hospital and Research Center Lalitpur Nepal
Hematology Unit Terrassa Hospital Terrassa Spain
Hospital Clínic de Barcelona Barcelona Spain
Hospital Italiano La Plata La Plata Argentina
Institute of Applied Biosciences Centre for Research and Technology Hellas Thessaloniki Greece
IRCSS Ospedale San Raffaele Milan Italy
Lymphoma Center Clinic for Hematology University Clinical Center of Serbia Belgrade Serbia
S C Ematologia ASST Spedali Civili Brescia Brescia Italy
Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
SC Ematologia AO S Croce e Carle Cuneo Italy
Section of Hematology Department of Medical Sciences University of Modena and Reggio E Modena Italy
Spanish Society of Haematology and Hemotherapy Madrid Spain
St Anna University Hospital Ferrara Italy
Università Vita Salute San Raffaele and IRCC Ospedale San Raffaele Milan Italy
University Hospital and Research Institute of Marqués de Valdecilla Santander Spain
Citace poskytuje Crossref.org
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- $a Antic, Darko $u Lymphoma Center, Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia. darko.antic1510976@gmail.com $u Faculty of Medicine, University of Belgrade, Belgrade, Serbia. darko.antic1510976@gmail.com
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- $a Thrombotic and bleeding complications in patients with chronic lymphocytic leukemia and severe COVID-19: a study of ERIC, the European Research Initiative on CLL / $c D. Antic, N. Milic, T. Chatzikonstantinou, L. Scarfò, V. Otasevic, N. Rajovic, D. Allsup, A. Alonso Cabrero, M. Andres, M. Baile Gonzales, A. Capasso, R. Collado, R. Cordoba, C. Cuéllar-García, JG. Correa, L. De Paoli, MR. De Paolis, G. Del Poeta, M. Dimou, M. Doubek, M. Efstathopoulou, S. El-Ashwah, A. Enrico, B. Espinet, L. Farina, A. Ferrari, M. Foglietta, A. Lopez-Garcia, JA. García-Marco, R. García-Serra, M. Gentile, E. Gimeno, MG. da Silva, O. Gutwein, YK. Hakobyan, Y. Herishanu, JÁ. Hernández-Rivas, T. Herold, G. Itchaki, O. Jaksic, A. Janssens, OB. Kalashnikova, E. Kalicińska, AP. Kater, S. Kersting, M. Koren-Michowitz, J. Labrador, D. Lad, L. Laurenti, A. Fresa, MD. Levin, C. Mayor Bastida, L. Malerba, R. Marasca, M. Marchetti, J. Marquet, B. Mihaljevic, I. Milosevic, F. Mirás, M. Morawska, M. Motta, T. Munir, R. Murru, R. Nunes, J. Olivieri, MA. Pavlovsky, I. Piskunova, VM. Popov, FM. Quaglia, G. Quaresmini, G. Reda, GM. Rigolin, A. Shrestha, M. Šimkovič, S. Smirnova, M. Špaček, P. Sportoletti, O. Stanca, N. Stavroyianni, D. Te Raa, K. Tomic, S. Tonino, L. Trentin, E. Van Der Spek, M. van Gelder, M. Varettoni, A. Visentin, C. Vitale, V. Vukovic, E. Wasik-Szczepanek, T. Wróbel, LYS. Segundo, M. Yassin, M. Coscia, A. Rambaldi, E. Montserrat, R. Foà, A. Cuneo, M. Carrier, P. Ghia, K. Stamatopoulos
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- $a 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.
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- $a De Paolis, Maria Rosaria $u UOC Ematologia PO Vito Fazzi Lecce, Lecce, Italy
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- $a Del Poeta, Giovanni $u Department of Biomedicine and Prevention Hematology, University Tor Vergata, Rome, Italy
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