title: Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer.
abstract: BACKGROUND
  Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can't reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood.
  
  
  OBJECTIVE
  Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients.
  
  
  METHODS
  Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45-79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The continuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation.
  
  
  RESULTS
  Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3-58.7), males 50 s (42-71.2) vs 51 s (42-59), p = 0.1210 / 53 s (42-74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62-100), p = 0.0128 / 80 s (59-124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9-82.5), males 63 mm (56-73.7) vs 69 mm (59-95.8), p = 0.9911 / 69 mm (53.6-90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3-49.5) males 18 mm / 100 s (11-27) vs 15 mm 100 s (11.8-22), p < 0.001 / 13 mm / 100 s (10-21.8), p < 0.001 in controls. The t-MaxVel was shortened in cancer patients: females 65s (48.6-112.8), males 81s (50.1-135.9) vs 115s (56.8-166), p < 0.001 / 115 s (59.8-180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100(5511-8148), males 5984 mm 100 (5119-6899) vs 5778 mm 100 (4998-6655), p < 0.001 / 5662 mm 100 (4704-6385), p = 0.0105.
  
  
  CONCLUSIONS
  Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery.
authors: Laboratory of Haemostasis and Thrombosis, San Giovanni Bosco Hospital of Naples, Naples, Italy.
authors: M L
authors: ML
authors: Papa
authors: F
authors: F
authors: Capasso
authors: L
authors: L
authors: Pudore
authors: S
authors: S
authors: Torre
authors: S
authors: S
authors: Mango
authors: V
authors: V
authors: Russo
authors: P
authors: P
authors: Delrio
authors: R
authors: R
authors: Palaia
authors: F
authors: F
authors: Ruffolo
authors: M D
authors: MD
authors: d'Eufemia
authors: D
authors: D
authors: De Lucia
authors: M
authors: M
authors: Napolitano
authors: P
authors: P
authors: Di Micco
authors: V
authors: V
authors: Parisi
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001780:Blood Coagulation Tests; D002277:Carcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D013916:Thrombelastography / Q000295:instrumentation / Q000592:standards*; D013923:Thromboembolism / Q000097:blood* / Q000209:etiology