Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography

Agha, Ali; Gill, Clarence; Balanescu, Dinu Valentin; Donisan, Teodora; Palaskas, Nicolas; Lopez‐Mattei, Juan; Hassan, Saamir; Kim, Peter Y.; Charitakis, Konstantinos; Çilingiroğlu, Mehmet; Oo, Thein Hlaing; Kroll, Michael H.; Durand, Jean Bernard; Hirsch-Ginsberg, Cheryl F; Marmagkiolis, Konstantinos; Iliescu, Cezar

doi:10.3389/fcvm.2020.00009

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…In thrombocytopenic patients, platelet function rather than platelet count often correlates with bleeding, and hemostasis appears to be affected more than platelet adhesion (17,18). TEG results in thrombocytopenic cancer patients with PE may provide a more comprehensive risk stratification before pericardiocentesis, and may help determine the appropriate blood product administration when hemorrhagic complications arise, approach already established for the coronary procedures (19).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Wilson

Lee

Gill

et al. 2021

Front. Cardiovasc. Med.

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Background: Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the management of malignancy-related pericardial effusion in patients with thrombocytopenia.Objectives: Our study aimed to analyze prognostic factors and overall survival (OS) after pericardiocentesis in thrombocytopenic cancer patients.Methods and Results: A retrospective review of 136 thrombocytopenic cancer patients who underwent primary percutaneous pericardiocentesis was performed. Degree of thrombocytopenia was classified by platelet count recorded on day of pericardiocentesis: 75–149 × 103 cells/μL (41%); 50–74 × 103 cells/μL (10%); 25–49 × 103 cells/μL (24%); <25 × 103 cells/μL (25%). Median OS was 2.6 months and median follow-up was 37.4 months. Kaplan-Meier survival analysis showed significant OS differences among thrombocytopenia severity groups (p = 0.023), and worse OS with platelets <100 vs. ≥100 × 103 cells/μL (p = 0.031). By univariate analysis, thrombocytopenia severity was associated with increased risk of death (HR 0.993; 95% CI 0.989–0.997; p = 0.002). Poor prognostic factors for OS were advanced cancer, malignant effusion, elevated international normalized ratio (INR), quantity of platelet transfusions, and platelet transfusion resistance. However, thrombocytopenia severity became insignificant for OS (p = 0.802), after adjusting for advanced cancer and INR.Conclusions: For patients with malignancy-related large pericardial effusion and thrombocytopenia, pericardiocentesis is a feasible intervention and should be considered due to low complication rates. There is no absolute contraindication to pericardiocentesis in case of hemodynamic instability, even with severe thrombocytopenia.

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Wilson

Lee

Gill

et al. 2021

Front. Cardiovasc. Med.

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“…Assessment of coagulopathy in cancer and hematologic disorders remains an open and promising field, with expansion of whole blood-based technologies. 113,[114][115][116] However, unless randomized controlled trials are conducted in the future, little progress can be made. The same situation occurred a decade ago with the use of VETs to guide blood component therapy in a goal-directed fashion in trauma resuscitation.…”

Section: Resultsmentioning

confidence: 99%

“…Despite this, Tables 1 and 2 reveal substantial literature describing the use of TEG and ROTEM to guide practice regarding coagulopathic patients with MAC and hematologic malignancy–associated coagulopathies. Assessment of coagulopathy in cancer and hematologic disorders remains an open and promising field, with expansion of whole blood–based technologies 113,114‐116 . However, unless randomized controlled trials are conducted in the future, little progress can be made.…”

Section: Resultsmentioning

confidence: 99%

Viscoelastic testing in oncology patients (including for the diagnosis of fibrinolysis): Review of existing evidence, technology comparison, and clinical utility

et al. 2020

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The quantification of the coagulopathic state associated with oncologic and hematologic diseases is imperfectly assessed by common coagulation tests such as prothrombin time, activated partial thromboplastin time, fibrinogen levels, and platelet count. These tests provide a static representation of a component of hemostatic integrity, presenting an incomplete picture of coagulation in these patients. Viscoelastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), as whole blood analyses, provide data related to the cumulative effects of blood components and all stages of the coagulation and fibrinolytic processes. The utility of VETs has been demonstrated since the late 1960s in guiding blood component therapy for patients undergoing liver transplantation. Since then, the scope of viscoelastic testing has expanded to become routinely used for cardiac surgery, obstetrics, and trauma. In the past decade, VETs' expanded usage has been most significant in trauma resuscitation. However, use of VETs for patients with malignancy‐associated coagulopathy (MAC) and hematologic malignancies is increasing. For the purposes of this narrative review, we discuss the similarities between trauma‐induced coagulopathy (TIC) and MAC. These similarities center on the thrombomodulin‐thrombin complex as it switches between the thrombin‐activatable fibrinolysis inhibitor coagulation pathway and activating the protein C anticoagulation pathway. This produces a spectrum of coagulopathy and fibrinolytic alterations ranging from shutdown to hyperfibrinolysis that are common to TIC, MAC, and hematologic malignancies. There is expanding literature regarding the utility of TEG and ROTEM to describe the hemostatic integrity of patients with oncologic and hematologic conditions, which we review here.

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“…- Found patients with >50,000/mm 3 platelet count as well as normal TEG parameters had improved overall survival suggesting these tests can effectively establish a cut-off for coronary angiography in cancer patients 45…”

Section: Role Of Thromboelastography In Other Cancersmentioning

confidence: 98%

“…- Investigated whether platelet count and TEG can predict bleeding risk/mortality among cancer patients undergoing coronary angiography 45…”

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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Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography

Cited by 9 publications

References 25 publications

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

Viscoelastic testing in oncology patients (including for the diagnosis of fibrinolysis): Review of existing evidence, technology comparison, and clinical utility

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

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