Relationship of Coagulation Test Abnormalities to Tumour Burden and Postoperative DVT in Resected Colorectal Cancer

Abstract

SummaryIn a prospective study, coagulation test results were compared in 137 patients with colorectal cancer (CRC) and 39 subjects with benign colorectal diseases. Prothrombin fragment 1+2 (F1+2), thrombinantithrombin complex (TAT), and soluble fibrin (SF) were measured in plasma before and after surgery. CRC patients presented with significantly higher values of F1+2 and TAT than controls. Patients with localised CRC had elevated values of F1+2 and TAT, whereas patients with advanced CRC also had elevated SF values. TAT and SF levels correlated with tumour spread, and normal values virtually excluded advanced cancer. Postoperative deep venous thrombosis (DVT) was diagnosed by phlebography in 20% of the CRC patients. Preoperative values of the markers did not predict postoperative DVT, but postoperative values did.

Thrombin Generation Markers as Predictors of Cancer-Associated Venous Thromboembolism: A Systematic Review

“…2). Of these, 11 studies reported data on F1.2 15,19,[25][26][27][28][29][30][31][32][33] (►Table 2), nine studies reported data on TAT [25][26][27]30,[33][34][35][36][37] (►Table 3), and 12 studies reported data Embase ('malignant neoplasm'/exp OR cancer à OR neoplasm à OR malignanc à ) AND ('thromboembolism'/exp OR "venous thromboembolism" OR "venous thrombo-embolism" OR "venous thrombosis" OR "deep vein thromboembolism" OR "deep vein thrombosis" OR "portal thrombosis" OR "sinus thrombosis" OR "mesenterial thrombosis" OR "cerebral vein thrombosis" OR "cancer-associated thrombosis" OR "VTE" OR "DVT") AND ('thrombin'/exp OR 'thrombography'/exp OR "thrombin" OR "calibrated automated thrombogram" OR "thrombography" OR "prothrombin" OR 'thrombin antithrombin complex'/exp OR "TAT" OR "thrombinantithrombin") NOT 'conference abstract'/it on thrombin generation 13,21,28,29,31,[38][39][40][41][42][43][44] (►Table 4). Of the 24 included papers, 13 were rated as good, eight as fair, and three studies were rated as poor.…”

“…Some variability in sample processing and analysis between studies was noted. For instance, Leiba et al 41 used a shorter centrifugation time, and Iversen et al 26,27 and Kirwan et al 34 utilized cooled centrifugation, which may impact results. However, the number of commercially available assays are limited, and the analysis principles are largely similar within the three analyses.…”

“…Most studies were performed on patients with solid cancers (n ¼ 17). 13,15,[25][26][27][29][30][31][32][34][35][36][37][38]40,42,44 Studies on purely hematological cancer patients were few (n ¼ 3). 39,41,43 The remaining four studies had mixed study groups.…”

“…Seven studies were performed on cancer patients undergoing surgery [25][26][27][36][37][38]44 investigating postoperative VTE, and five studies were performed in cohorts where >30% of the population underwent surgery. 19,21,30,34,35 In nine studies, all the patients received chemotherapy, 13,15,29,34,[39][40][41][42][43] and in five, studies some patients received chemotherapy.…”

“…19,21,30,34,35 In nine studies, all the patients received chemotherapy, 13,15,29,34,[39][40][41][42][43] and in five, studies some patients received chemotherapy. 19,21,30,35,38 Thromboprophylaxis was allowed in 13 studies, 15,19,21,[25][26][27]29,31,36,[38][39][40]44 and therapeutic doses were allowed in four studies. 30,32,37,41 In total, 10 out of 11 studies investigating F1.2 used the same enzyme immunoassay.…”