TY - JOUR
T1 - Persistence of hypercoagulable state after resection of intra-abdominal malignancies
AU - Thorson, Chad M.
AU - Van Haren, Robert M.
AU - Ryan, Mark L.
AU - Curia, Emiliano
AU - Sleeman, Danny
AU - Levi, Joe U.
AU - Livingstone, Alan S.
AU - Proctor, Kenneth G.
N1 - Funding Information:
Supported in part by grants N140610670 from the Office of Naval Research and W81XWH1120098 from US Army Medical Research and Material Command .
PY - 2013/4
Y1 - 2013/4
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jamcollsurg.2012.12.006
DO - 10.1016/j.jamcollsurg.2012.12.006
M3 - Article
C2 - 23313542
AN - SCOPUS:84875370136
SN - 1072-7515
VL - 216
SP - 580
EP - 589
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -