Utility of Thromboelastography to Identify Hypercoagulability in Lung Cancer Related Ischemic Stroke Patients

Abstract

Lung cancer related hypercoagulability could increase the risk of ischemic stroke. Routine coagulation tests may have limited capacity in evaluating hypercoagulability. The aim of this study was to investigate the ability of thromboelastography (TEG) in the identification of hypercoagulability in patients with lung cancer and cryptogenic ischemic stroke (LCIS). Between January 2016 and December 2018, whole citrated blood from LCIS patients (n = 35) and age- and gender-matched lung cancer patients and healthy volunteers were used for TEG and routine coagulation tests. The coagulation indicator and clinical data were compared among the 3 groups. There were 27/35 (77.14%) on TEG and 18/35 (51.43%) on routine coagulation tests of LCIS patients who had evidence of hypercoagulability. The detection rate of hypercoagulability by TEG in LCIS patients was higher than routine coagulation tests ( P = 0.018). Comparing with lung cancer patients and healthy controls, LCIS patients have a significantly higher maximum amplitude (MA), fibrinogen, and D-dimer. Multivariate analysis showed that D-dimer and MA were significantly associated with ischemic stroke in lung cancer patients. ROC curve showed that the area under the curve of TEG (0.790 ± 0.048, 95% CI: 0.697-0.864) was significantly higher than routine coagulation tests (0.673 ± 0.059, 95% CI: 0.572-0.763) ( P = 0.04) in identifying hypercoagulability in LCIS patients. Therefore, TEG could identify hypercoagulability in LCIS patients and healthy controls. Identification of hypercoagulability in lung cancer patients by TEG may be helpful to prevent the occurrence of LCIS.

The Hypercoagulable Profile of Patients with Bone Tumors: A Pilot Observational Study Using Rotational Thromboelastometry

“…These findings indicate that the current definitions for hypercoagulability based on ROTEM parameters may be inadequate to describe certain clinical settings. In another study by Quan et al, the authors also evaluated the hemostatic profile of lung cancer patients, using TEG [ 27 ]. The authors reported that the Maximum Amplitude (MA), a TEG parameter similar to the ROTEM MCF, was significantly higher in cancer patients compared to age- and gender-matched controls and that the detection rate of hypercoagulability was higher for TEG compared to conventional coagulation tests.…”

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

“…44 TEG could identify hypercoagulability in patients with lung cancer and cryptogenic ischemic stroke significantly better than routine coagulation tests. 37 Together with platelet count greater than 50,000, normal TEG was able to predict survival in cancer patients with suspected coronary artery disease 45 and can be an independent predictive parameter for severity in lung cancer and also cancer progression as evidenced by node, and metastasis in lung adenocarcinoma than in the entire lung cancer population. 46 In gynecological cancers, there has been some contradictory findings.…”

Clinical Application of Thromboelastography in Acute Ischemic Stroke

“…This may denote the contribution of enhanced clot formation rather than decreased fibrinolytic activity in LCIS patients. 41 To better understand the mechanisms of cocaine use in acute stroke patients, Almaghrabi and colleagues analyzed the TEG parameters between cocaine users and non-cocaine users with either AIS or spontaneous intracerebral hemorrhage. They found that shortened median R time, reduced MA and G existed in patients of cocaine users.…”

“…Meanwhile, TEG has been wildly used in bleeding events in coronary surgeries, postpartum hemorrhage, and intracerebral hemorrhage. 4 , 6 – 45 However, only a few studies investigated the role of TEG in bleeding events in AIS patients. Compared to CCTs, the parameter R is supposed to be superior to indicating the symptomatic intracranial hemorrhage after endovascular therapy.…”