Markers of coagulation and angiogenesis in cancer-associated venous thromboembolism.
OBJECTIVE
We sought to determine whether venous thromboembolism in cancer patients is associated with aberrant plasma levels of hemostatic and angiogenic factors.


METHODS
Peripheral blood was collected before anticoagulant therapy from cancer patients with acute deep venous thrombosis (DVT; DVT + cancer group, n = 32), those without DVT (cancer control group, n = 36), and patients with acute DVT but no cancer (DVT control group, n = 58). Plasma assays of activation and inhibition of coagulation and fibrinolysis, as well as angiogenesis activation, were then performed.


RESULTS
Median levels of thrombin-antithrombin complex, prothrombin fragments 1 + 2, and von Willebrand factor antigen were significantly greater in the DVT + cancer group than in the cancer control and DVT control groups (17.8 ng/mL v 4.6 ng/mL and 9.8 ng/mL, P =.0001 and P =.003, respectively; 3.65 nmol/L v 1.60 nmol/L and 2.71 nmol/L, P <.0001 and P =.011, respectively; and 4.04 U/mL v 2.26 U/mL and 2.06 U/mL, P <.0001, respectively). Median levels of tissue-type plasminogen activator were also significantly higher, while protein C activity was lower in the DVT + cancer group than in the DVT control group (14.6 ng/mL v 9.50 ng/mL, respectively, P =.0005; 0.89 U/mL v 1.11 U/mL, respectively, P =.0008).


CONCLUSIONS
These data not only support prior observations of coagulation activation in patients with malignancy, but also provide new evidence for enhanced coagulation activation in the setting of acute venous thromboembolism in cancer. Future prospective studies are warranted to determine whether these and other potential markers of hypercoagulability may help to identify cancer patients at highest risk for venous thromboembolism.
Goldenberg
Neil
N
Department of Internal Medicine, University of South Florida, Tampa, FL, USA. goldenberg.neil@tchden.org
Kahn
Susan R
SR
Solymoss
Susan
S
D015415:Biomarkers / Q000032:analysis*; D001779:Blood Coagulation Factors / Q000032:analysis*; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000098:blood supply / Q000378:metabolism* / Q000473:pathology; D009389:Neovascularization, Pathologic; D011486:Protein C / Q000378:metabolism; D012307:Risk Factors; D013923:Thromboembolism / Q000378:metabolism*; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D020246:Venous Thrombosis / Q000150:complications / Q000378:metabolism*; D014841:von Willebrand Factor / Q000378:metabolism
D015415:Biomarkers; D001779:Blood Coagulation Factors; D011486:Protein C; D014841:von Willebrand Factor; D010959:Tissue Plasminogen Activator