Ex vivo properties of plasma clot formation and lysis in patients with cancer at risk for venous thromboembolism, arterial thrombosis, and death

被引:8
|
作者
Posch, Florian
Hofer, Stefanie
Thaler, Johannes
Hell, Lena
Konigsbrugge, Oliver
Grilz, Ella
Mauracher, Lisa-Marie
Gebhart, Johanna
Marosi, Christine
Jilma, Bernd
Pabinger, Ingrid
Ay, Cihan
机构
[1] Med Univ Vienna, Comprehens Canc Ctr Vienna, Dept Med 1, Clin Div Haematol & Haemostaseol, Vienna, Austria
[2] Med Univ Graz, Dept Internal Med, Div Oncol, Graz, Austria
[3] Ctr Biomarker Res Med CBmed GesmbH, Graz, Austria
[4] Med Univ Vienna, Comprehens Canc Ctr Vienna, Dept Med 1, Clin Div Oncol, Vienna, Austria
[5] Med Univ Vienna, Dept Clin Pharmacol, Vienna, Austria
[6] Sechenov Univ, IM Sechenov Moscow State Med Univ 1, Moscow, Russia
基金
奥地利科学基金会;
关键词
FIBRIN FORMATION; VIENNA CANCER; D-DIMER; GENERATION; DISEASE; INFLAMMATION;
D O I
10.1016/j.trsl.2019.08.009
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
A prothrombotic state is frequently observed in patients with cancer and contributes to the risks of venous thromboembolism (VTE), arterial thromboembolism (ATE), tumor progression, and death. Altered ex vivo properties of plasma clot formation and lysis have been observed in patients with cancer. The aim of this prospective study was to comprehensively characterize the relationship between plasma clot properties, inflammation, hypercoagulability, thrombotic complications, and mortality in patients with cancer using a tissue-factor-based turbidimetric assay of clot formation and lysis. Turbidity parameters were determined in 815 patients with newly-diagnosed or recurrent cancer and 97 healthy controls. Patients were followed-up for 2 years and rates of VIE (n = 72 events), ATE (n = 21 events), and death (n = 304 events) were assessed. Compared to controls, cancer patients' turbidity profiles showed an increased clot formation potential and higher resistance toward fibrinolysis. Elevated biomarkers of inflammation and hemostasis, such as C-reactive protein, FVIII, and thrombin generation explained substantial amounts of variation in turbidity parameters. In a prospective analysis, altered parameters of clot formation identified cancer patients at high risk of ATE (Hazard ratio (HR) per doubling of peak absorbance: 4.43, 95% CI: 1.50-13.07, P=0.007) and death (HR per doubling of peak absorbance: 2.73, 2.00-3.72, P<0.0001); these findings were independent of other prognostic covariates. Contrarily, turbidity parameters were not associated with risk of VTE (HR per doubling of peak absorbance: 1.15, 0.66-2.01, P=0.62). We conclude that patients with cancer have altered ex vivo properties of clot formation which predict risks of ATE and mortality but not VTE.
引用
收藏
页码:41 / 56
页数:16
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