title: Thoracic tumor effects on plasmatic coagulation: role of hemeoxygenase-1.
abstract: OBJECTIVE
  Lung cancer is an important health threat worldwide, and is associated with a 3.8-13.9% incidence of thrombophilia. Of interest, patients with lung tumors have been noted to have an increase in endogenous carbon monoxide production via upregulation of hemeoxygenase-1 activity. Given that it has been demonstrated that carbon monoxide enhances plasmatic coagulation in vitro and in vivo via formation of carboxyhemefibrinogen, we sought to determine if patients with thoracic tumors undergoing lung resection/pneumonectomy had an increase in endogenous carbon monoxide and concurrent plasmatic hypercoagulability.
  
  
  METHODS
  Nonsmoking patients with thoracic tumors (n=19) had preoperative carboxyhemoglobin (a measure of carbon monoxide production) determined, and a thromboelastometric method to assess citrated plasma coagulation kinetics and the formation of carboxyhemefibrinogen was utilized. Thoracic tumor patient coagulation kinetics was compared with normal subject (n=30) plasma samples.
  
  
  CONCLUSIONS
  Patients with thoracic tumors were determined to have an abnormally increased carboxyhemoglobin concentration of 2.1±0.6%, indicative of hemeoxygenase-1 upregulation. It was found that 84% of thoracic tumor patients had plasma clot strength that exceeded the 95% confidence interval value observed in normal subjects, and 44% of this hypercoagulable subgroup had carboxyhemefibrinogen formation. Future investigation of the role played by plasmatic hypercoagulability and hemeoxygenase-1 derived carboxyhemefibrinogen in the pathogenesis of thoracic tumor related thrombophilia is warranted.
authors.affiliation: Department of Anesthesiology, The University of Arizona College of Medicine, United States. Electronic address: vgnielsen@email.arizona.edu.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Nielsen
authors.affiliation: Department of Surgery, The University of Arizona College of Medicine, United States.
authors.forename: Farid
authors.initials: F
authors.lastname: Gharagozloo
authors.affiliation: Department of Anesthesiology, The University of Arizona College of Medicine, United States.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Matika
authors.affiliation: Department of Surgery, The University of Arizona College of Medicine, United States.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, The University of Arizona College of Medicine, United States.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Zelman
authors.affiliation: Department of Anesthesiology, The University of Arizona College of Medicine, United States.
authors.forename: Evangelina B
authors.initials: EB
authors.lastname: Steinbrenner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D002248:Carbon Monoxide / Q000378:metabolism; D002263:Carboxyhemoglobin / Q000378:metabolism; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D051547:Heme Oxygenase-1 / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013899:Thoracic Neoplasms / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology*; D013916:Thrombelastography; D019851:Thrombophilia / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology*; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D002248:Carbon Monoxide; D002263:Carboxyhemoglobin; D051547:Heme Oxygenase-1
keywords: Coagulation; Fibrinogen; Lung cancer; Thromboelastometry; Venous thromboembolism