title: Thrombin generation as a predictor of thromboembolic events in multiple myeloma patients.
abstract: Multiple myeloma (MM) is characterized by an increased incidence of thromboembolic events, especially when immunomodulatory drugs are used. Currently, our ability to predict these thrombotic events is limited. We hypothesized that global coagulation tests may be predictive of thrombotic events in MM patients.
  
  
  
  Blood samples were taken from 36 MM patients before and during routine treatment. Thrombin generation (TG) tests including endogenous thrombin potential (ETP) and peak height were analyzed.
  
  
  
  Patients were followed for a median of 2.5years. Those who developed thrombotic events were characterized by significantly higher ETP and peak height values compared to those who did not (P=0.001). In these patients, we identified a gradual increase in TG parameters that preceded the thrombotic event. Anticoagulation therapy was associated with a significant decrease in ETP and peak height values (P<0.001). There was no statistically significant difference in TG parameters between newly diagnosed MM patients and healthy subjects, as well as between MM patients prior to and during chemotherapy.
  
  
  
  TG tests might predict thrombotic events in MM patients. Thus, TG tests may be incorporated into decision-making protocols of prophylactic anticoagulant therapy in MM patients.
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Merav
authors.initials: M
authors.lastname: Leiba
authors.affiliation: Division of Pediatrics B, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Sarah
authors.initials: S
authors.lastname: Malkiel
authors.affiliation: Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Budnik
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rozic
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Avigdor
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Adrian
authors.initials: A
authors.lastname: Duek
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Cancer Research Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Gili
authors.initials: G
authors.lastname: Kenet
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; National Hemophilia Center and Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: tami.livnat@sheba.health.gov.il.
authors.forename: Tami
authors.initials: T
authors.lastname: Livnat
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D013917:Thrombin / Q000378:metabolism*; D013927:Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D013917:Thrombin
keywords: Cancer; Global coagulation tests; Multiple myeloma; Thrombin generation; Thrombosis