Incidence and trends in venous thromboembolism in the post-COVID era: Analysis of high-VTE risk vs intermediate-VTE risk malignancies using real-world data.

Abstract

708 Background: Studies have documented higher venous thromboembolism (VTE) rates with cancers such as stomach and pancreatic cancers. Additionally, COVID-19 have been associated with an increase in VTE risks. However, it is unclear if COVID-19 impacted VTE risk profiles of cancers. This study aims to evaluate the incidence in VTE for high-VTE risk malignancies and intermediate-VTE risk malignancies and additionally evaluate for potential impact of COVID-19 on risk. Methods: Retrospective analysis using the TriNetX global health research database within the US Collaborative Network was completed for this study. Malignancies were examined based on prior known VTE risks as high risk (stomach and pancreatic cancer) vs intermediate risk (lymphoid, lung, gynecological, testicular, bladder cancer) without prior reported history of VTE. VTE was defined as either of pulmonary embolism or deep venous thrombosis of any extremity. The incidence of VTE was examined for malignancies of interest diagnosed between January 2015 and December 2025, grouped into pre-COVID (January 2015 to December 2019), COVID (January-December 2020) and post-COVID (January 2021-December 2025). Post-COVID survival analysis was carried out on propensity-matched categories for high-VTE risk vs intermediate-VTE risk cancers. Results: Overall, 1,619,634 high-VTE and intermediate-VTE risk malignancies were reported. VTE showed an increased trend in the post-COVID era with incidence proportions of 0.51% (6,735) in the pre-COVID era, 0.20% (2,203) in the COVID era and 1.37% (17,210) in the post-COVID era. Females had slightly lower incidence proportions [0.50% (3,606), 0.19% (1,187) and 1.36% (9,296) in the pre-, COVID, and post-COVID eras respectively] while Black patients had higher incidence proportions [0.72% (1,034), 0.27% (329) and 2.10% (2,841) in the pre-, COVID, and post-COVID eras respectively] compared to their counterparts. There were 1,473,972 intermediate-VTE risk malignancies and 161,245 high-VTE risk malignancies. Similarly, both cancer categories had an increased VTE trend in the post-COVID era. Pre-COVID, COVID and post-COVID eras VTE incidence was 0.46% (5,579), 0.18% (1,856), and 1.27% (14,750) 0.96% (1229) for intermediate-VTE risk and 0.96% (1229), 0.38% (370), and 2.41% (2673) for the high-VTE risk malignancies respectively. In both categories and across all COVID eras, females and Black patients had higher VTE incidences compared to their counterparts. In the post-COVID era, high-VTE risk continued to demonstrate higher risk of VTE within 2 years of diagnosis when compared to intermediate-VTE risk (HR 3.05, 95% CI 2.90, 3.19) with survival probabilities of 96.0% and 98.6% respectively. Conclusions: Real-world data shows higher VTE incidences in the post-COVID 19 era for both high-VTE and intermediate-VTE risk malignancies. Comparatively, high-VTE risk cancer had significantly higher risk of VTE in the post-COVID era. Further studies are needed to delineate potential factors driving the increasing trend in VTE incidence in the post-COVID 19 era.