title: Follow-up of thrombin generation after prostate cancer surgery: global test for increased hypercoagulability.
abstract: Recent studies provided evidence that evaluation of thrombin generation identifies patients at thrombotic risk. Thrombin generation has a central role in hemorrhage control and vascular occlusion and its measurement provides new metrics of these processes providing sufficient evaluation of an individual's hemostatic competence and response to anticoagulant therapy. The objective of the study is to assess a new measure of hypercoagulability that predisposes to venous thromboembolism in the postoperative period after radical prostatectomy. Pre- (day-1) and postoperative (hour 1, day 6, month 1 and 10) blood samples of 24 patients were tested for plasma thrombin generation (peak thrombin), routine hematology and hemostasis. Patients received low molecular weight heparin for thromboprophylaxis. Peak thrombin levels were higher in patients compared to controls at baseline (p<0.001), and elevated further in the early postoperative period (p<0.001). Longer general anesthesia and high body mass index were associated with increased thrombin generation after surgery (p = 0.024 and p = 0.040). D dimer and fibrinogen levels were higher after radical prostatectomy (p = 0.001 and p<0.001). Conventional clotting tests remained within the reference range. Our study contributed to the cognition of the hypercoagulable state in cancer patients undergoing pelvic surgery and revealed the course of thrombin generation after radical prostatectomy. Whilst it is unsurprising that thrombin generation increases after tissue trauma, further evaluation of this condition during the postoperative period would lead urologists to an international and well-supported consensus regarding thromboprophylaxis in order to provide better clinical outcome. Considering the routine evaluation of procoagulant activity and extending prophylactic anticoagulant therapy accordingly may potentially prevent late thrombotic events.
authors.affiliation: Department of Urology, Medical and Health Science Center, University of Debrecen, Hungary.
authors.forename: Matyas
authors.initials: M
authors.lastname: Benyo
authors.forename: Tibor
authors.initials: T
authors.lastname: Flasko
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Molnar
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kerenyi
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Batta
authors.forename: Tamas
authors.initials: T
authors.lastname: Jozsa
authors.forename: Jolan
authors.initials: J
authors.lastname: Harsfalvi
mesh_terms: D000368:Aged; D001772:Blood Cell Count; D015992:Body Mass Index; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D018709:Statistics, Nonparametric; D013917:Thrombin / Q000096:biosynthesis*; D019851:Thrombophilia / Q000175:diagnosis* / Q000209:etiology
chemical_list: D005340:Fibrinogen; D013917:Thrombin; D017430:Prostate-Specific Antigen