Persistence of hypercoagulable state after resection of intra-abdominal malignancies

Chad M. Thorson, Robert M. Van Haren, Mark L. Ryan, Emiliano Curia, Danny Sleeman, Joe U. Levi, Alan S. Livingstone, Kenneth G. Proctor

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)580-589
Number of pages10
JournalJournal of the American College of Surgeons
Volume216
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Thrombophilia
Neoplasms
Thrombelastography
Venous Thromboembolism
Bile Ducts
Informed Consent
Pancreatic Neoplasms
Duodenum
Esophagus
Stomach

ASJC Scopus subject areas

  • Surgery

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Persistence of hypercoagulable state after resection of intra-abdominal malignancies. / Thorson, Chad M.; Van Haren, Robert M.; Ryan, Mark L.; Curia, Emiliano; Sleeman, Danny; Levi, Joe U.; Livingstone, Alan S.; Proctor, Kenneth G.

In: Journal of the American College of Surgeons, Vol. 216, No. 4, 04.2013, p. 580-589.

Research output: Contribution to journalArticle

Thorson, CM, Van Haren, RM, Ryan, ML, Curia, E, Sleeman, D, Levi, JU, Livingstone, AS & Proctor, KG 2013, 'Persistence of hypercoagulable state after resection of intra-abdominal malignancies', Journal of the American College of Surgeons, vol. 216, no. 4, pp. 580-589. https://doi.org/10.1016/j.jamcollsurg.2012.12.006
Thorson, Chad M. ; Van Haren, Robert M. ; Ryan, Mark L. ; Curia, Emiliano ; Sleeman, Danny ; Levi, Joe U. ; Livingstone, Alan S. ; Proctor, Kenneth G. / Persistence of hypercoagulable state after resection of intra-abdominal malignancies. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 4. pp. 580-589.
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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.",
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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.

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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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