Assessment of hypercoagulability using thromboelastography predicts advanced status in renal cell carcinoma

Wang, Xun; Shi, An; Huang, Jiwei; Chen, Yonghui; Xue, Wei; Zhang, Jin

doi:10.1002/jcla.23017

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…For example, the TEG parameters K time, Angle, and MA can predict the stage of lung cancer [ 31 ]. It has also been reported that advanced colorectal cancer usually exhibits hypercoagulable status, and MA is a potential effective biomarker for the identification of such cancer [ 32 ]. In addition, TEG parameters were significantly abnormal in patients with thyroid cancer; among these parameters, Angle, CI, and thrombodynamic potential index (TPI) had potential diagnostic utility for this type of cancer [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Jiaao,

Wanli,

Kai

et al. 2023

Eur J Med Res

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Background In recent years, conventional coagulation (CC) and thromboelastography (TEG) parameters have been reported to be closely related to the progression of pancreatic cancer (PC). However, the potential utility of these parameters in differentiating benign and malignant pancreatic diseases is still unclear. Objectives A retrospective study was conducted to evaluate the efficacy of coagulation parameters in differentiating pancreatic cancer/early stage pancreatic cancer (EPC, TNM stages I and II) from benign control conditions, and to further explore whether coagulation parameters could improve the differential value of CA199. Methods Receiver operating characteristic (ROC) curves and logistic regression analysis were used to identify the diagnostic value of each coagulation parameter or combination of parameters. Results Compared with benign pancreatic disease (BPD), patients with pancreatic malignant tumors had significant coagulation disorders, specifically manifested as abnormal increases or decreases in several CC and TEG parameters (such as activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (DD2), K time, R time, Angle, maximum amplitude (MA), coagulation index (CI), and Ly30). In the training group, ROC curve showed that FIB, DD2, Angle, MA, and CI had favorable efficacy at differentiating PC or EPC from BPD (for PC, AUC = 0.737, 0.654, 0.627, 0.602, 0.648; for EPC, AUC = 0.723, 0.635, 0.630, 0.614, 0.648). However, several combined diagnostic indicators based on FIB, DD2 and CI failed to outperform the individual coagulation indexes in diagnostic efficiency. Combinations of certain coagulation indexes with CA199 outperformed CA199 alone at identifying PC or EPC, especially FIB + CA199 (for PC, AUC = 0.904; for EPC, AUC = 0.905), FIB + DD2 + CA199 (for PC, AUC = 0.902; for EPC, AUC = 0.900), FIB + CI + CA199 (for PC, AUC = 0.906; for EPC, AUC = 0.906), and FIB + DD2 + CI + CA199 (for PC, AUC = 0.905; for EPC, AUC = 0.900). The results from a validation set also confirmed that these combinations have advantageous diagnostic value for PC and EPC. Conclusions A significant hypercoagulable state was common in PC. Some CC and TEG parameters are valuable in the differential diagnosis of benign and malignant pancreatic diseases. In addition, coagulation indexes combined with CA199 can further enhance the differential diagnosis efficacy of CA199 in PC and EPC.

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Section: Discussionmentioning

confidence: 99%

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Jiaao,

Wanli,

Kai

et al. 2023

Eur J Med Res

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“…When it comes to MTP-related blood product usage, TEG does not differ from conventional testing and ROTEM [40,41]. During trauma surgery involving the liver and spleen, interestingly, TEG guidance has demonstrated less as well as increased blood product usage but shorter surgery time [42,43]. With the success of TEG in assessing coagulopathic parameters in trauma patients, TEG has been investigated for detecting and reversing anticoagulants only with limited success, and conventional tests (e.g., PT, INR, PTT) that have shown better results comparatively have been recommended [44][45][46][47].…”

Section: Traumamentioning

confidence: 99%

Thromboelastography in the Perioperative Period: A Literature Review

Ramanujam¹,

DiMaria²,

Varma³

2023

Cureus

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Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.

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“…50 A positive correlation was shown between fibrinogen and MA value and a particular MA value was helpful in detecting high-risk renal cell carcinoma. 51 In primary brain tumors where a hypercoagulable state is expected 24 hours postoperative, TEG was found to be useful perioperatively to identify coagulation abnormalities and guide treatment. 52…”

Section: Role Of Thromboelastography In Other Cancersmentioning

confidence: 99%

Hypercoagulability and Thrombosis Risk in Prostate Cancer: The Role of Thromboelastography

Fainchtein

Tera

Kearn

et al. 2022

Semin Thromb Hemost

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Thrombosis is one of the leading causes of death in cancer. Cancer-induced hypercoagulable state contributes to thrombosis and is often overlooked. Prostate cancer may not be of high thrombogenic potential compared with other cancers, but its high prevalence brings it into focus. Pathological evidence for venous thromboembolisms (VTEs) in prostate cancer exists. Factors such as age, comorbidities, and therapies increase the VTE risk further. There is a need to systematically identify the risk of VTE in regard to patient-, cancer-, and treatment-related factors to risk stratify patients for better-targeted and individualized strategies to prevent VTE. Sensitive tests to enable such risk assessment are urgently required. There is sufficient evidence for the utility of thromboelastography (TEG) in cancer, but it is not yet part of the clinic and there is only limited data on the use of TEG in prostate cancer. One study revealed that compared with age-matched controls, 68.8% of prostate cancer patients demonstrated hypercoagulable TEG parameters. The absence of clinical guidelines is a limiting factor in TEG use in the cancer population. Cancer heterogeneity and the unique cancer-specific microenvironment in each patient, as well as determining the hypercoagulable state in each patient, are added limitations. The way forward is to combine efforts to design large multicenter studies to investigate the utility and clinical effectiveness of TEG in cancer and establish longitudinal studies to understand the link between hypercoagulable state and development of thrombosis. There is also a need to study low thrombogenic cancers as well as high thrombogenic ones. Awareness among clinicians and understanding of test applicability and interpretation are needed. Finally, expert discussion is critical to identify the investigation priorities.

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Assessment of hypercoagulability using thromboelastography predicts advanced status in renal cell carcinoma

Cited by 6 publications

References 19 publications

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Thromboelastography in the Perioperative Period: A Literature Review

Hypercoagulability and Thrombosis Risk in Prostate Cancer: The Role of Thromboelastography

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