title: Persistence of hypercoagulable state after resection of intra-abdominal malignancies.
abstract: BACKGROUND
  The hypercoagulable state associated with cancer imparts considerable risk for venous thromboembolism. Surgical resection of malignancies should theoretically reverse tumor-induced hypercoagulability. However, coagulation changes in cancer patients postresection have not been described thoroughly. Conventional coagulation tests are unable to detect hypercoagulable states. In contrast, rotational thromboelastography (ROTEM) can detect hypo- or hypercoagulable conditions. We hypothesized that the cancer-induced hypercoagulable state would improve after surgical resection.
  
  
  METHODS
  After informed consent, blood samples of patients undergoing surgical resection for curative intent were analyzed with serial ROTEM.
  
  
  RESULTS
  Thirty-five patients (mean ± SD age 66 ± 17 years; 67% male) had cancers involving the pancreas (n = 12 [34%]), esophagus (n = 10 [29%]), stomach (n = 7 [20%]), bile ducts (n = 3 [9%]), and duodenum (n = 3 [9%]). Preoperative ROTEM identified 14 (40%) who were hypercoagulable. After surgical resection, patients became progressively hypercoagulable with more rapid clot formation time (low clot formation time, high alpha) and higher maximum clot firmness. By week one, 86% (n = 30) had abnormal ROTEM values, including 17 of 21 (81%) who had normal coagulation profiles preoperatively. Most (n = 30 [86%]) remained hypercoagulable at 3 to 4 weeks.
  
  
  CONCLUSIONS
  Rotational thromboelastography identifies baseline hypercoagulability in more than one third of patients with intra-abdominal malignancies. This is among the first studies to demonstrate progressive hypercoagulability that persists for at least 1 month after resection. These data support postdischarge thromboprophylaxis regimens in high-risk cancer patients.
authors: Division of Surgical Oncology, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, FL 33136, USA.
authors: Chad M
authors: CM
authors: Thorson
authors: Robert M
authors: RM
authors: Van Haren
authors: Mark L
authors: ML
authors: Ryan
authors: Emiliano
authors: E
authors: Curia
authors: Danny
authors: D
authors: Sleeman
authors: Joe U
authors: JU
authors: Levi
authors: Alan S
authors: AS
authors: Livingstone
authors: Kenneth G
authors: KG
authors: Proctor
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography; D019851:Thrombophilia / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control