Comparative assessment of hypercoagulability in women with and without gynecologic malignancies using the thromboelastograph coagulation analyzer

Abstract

The hypercoagulability status of women with and without gynecologic malignancies was compared using the thromboelastograph coagulation analyzer. Blood specimens from 25 women with newly diagnosed gynecologic malignancies and from 21 age-matched controls were analyzed. Hypercoagulability is defined by a short R value (min), a short K value (min), an elevated maximum amplitude (MA) value (mm), and a broad alpha-angle (degrees). A two-tailed, two-sample t-test was used for statistical analysis. When compared with specimens from age-matched controls, specimens from women with gynecologic malignancies demonstrated values consistent with hypercoagulability. The specific parameters are presented as a mean (+/- SD). Patients with gynecologic malignancies were found to have a short R value (7.1 +/- 2.1 vs. 11.8 +/- 1.8 min; P < 0.001), a short K value (3.1 +/- 0.9 vs. 4.6 +/- 0.9 min; P < 0.001), a prolonged MA value (64.7 +/- 5.4 vs. 58.8 +/- 6.1 mm; P = 0.001), and a greater alpha-angle (70.6 +/- 5.3 vs. 61.6 +/- 4.9 degrees ; P < 0.001). Detection of hypercoagulability as measured by thromboelastography is statistically more common among women with gynecologic malignancies compared with age-matched controls. Future studies may address the use of thromboelastography to identify patients at risk for gynecologic malignancies.

Persistence of Hypercoagulable State after Resection of Intra-Abdominal Malignancies

“…Subsequently, TEG has been used to detect hypercoagulability in patients with cancers of the colon, breast, and gynecologic organs compared with healthy controls. [15][16][17] Recently, Papa and colleagues 31 used ROTEM to detect hypercoagulability in patients with solid digestive tract cancers. Although they found no difference in standard ROTEM variables (ie, clotting time, CFT, and MCF), they reported differences in maximum velocity and area under the curve, which are derived from the ROTEM curve.…”

“…This was done because numerous studies have already demonstrated that cancer patients are more hypercoagulable on TEG/ROTEM than healthy controls. [15][16][17]31,32 Third, only 40% of patients were hypercoagulable before surgery, and 86% became hypercoagulable after surgery. Although the presence of cancer seems to play a role, the tissue trauma imparted by major surgery also appears to contribute considerably to the overall hypercoagulable state.…”

“…Viscoelastic hemostatic assays have been used to detect hypercoagulable conditions in trauma, 12 after surgery, 10,13 and in patients with various malignancies. [14][15][16][17] However, there is a paucity of literature describing longitudinal coagulation changes in cancer patients. 14,18 The purpose of this study was to use ROTEM to prospectively evaluate the coagulation status of patients undergoing operative resection of intra-abdominal malignancies for curative intent.…”

Potential Antithrombotic Effects of Bupivacaine in Malignancies: An In Vitro Assesment Using Thromboelastography

“…Thromboelastography (TEG) is a sensitive method that is able to diagnose hypercoagulability which is not detected by routine coagulation tests [1] . It differs from other laboratory coagulation tests by measuring the clotting process from the time when fibrin strands are formed to fibrinolysis [3] . It is used to rapidly assess the interaction of platelets with the protein coagulation cascade from initial platelet-fibrin interaction, through platelet aggregation, clot strengthening, and fibrin crosslinking, to eventual clot lysis.…”

“…Wehrum et al [3] reported that hypercoagulability is more common among women with gynecologic malignancies compared with age-matched controls and the impact of thrombosis in gynecologic cancer patients is considerable in terms of inconvenience, mortality and morbidity. On the other hand, these patients usually need major surgical procedures and surgery itself is an important contributing factor to hypercoagulable states.…”