Abstract 128P
Background
Association of cancer and high risk of thromboembolic events (TEE) is well known and Khorana Score is the most validated risk assessment score to predict thromboembolism risk in cancer patients (pts). However, the hypercoagulability of cancer pts has not been evaluated with rotational thromboelastometry (ROTEM).
Methods
Patients with metastatic colorectal cancer (mCRC) suitable for chemotherapy were eligible. Control cases were selected among healthy blood donors. Blood samples of pts were collected on day 1 of chemotherapy. Complete blood counts, coagulation assays, ROTEM with Star-TEM reagent [clotting time (CT), clot formation time (CFT), alpha-angle (AA) and maximum clot firmness (MCF)], and ELISA assay for soluble forms of CD146, P-selectin, u-PA, and u-PAR were performed. Data from medical files and hematologic measurements were analyzed using IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.
Results
51 pts and 20 healthy volunteers were included from April to November 2011. ROTEM was performed on 33 pts. Compared to healthy donors, cancer pts had significantly higher white blood cell count (WBC), platelet count, MCF, and AA, as well as lower aPTT and CFT. Six pts (11.8%) were diagnosed with TEE during follow-up. The median time to TEE was 18.5 months (95% CI: 4-66). Logistic regression analysis was employed to predict the probability of developing a TEE and none of the evaluated variables had significant predictive or prognostic value. WBC, CFT, AA, and MCF were prognostic factors for progression/relapse in univariate analysis but this was not confirmed in the multivariate analysis. Table: 128P
Evaluated variables in patients and healthy controls
| Factor | Cancer pts (N=33) | Healthy controls (N=20) | p value |
| WBC | 8,428 | 6,637 | 0.004 |
| Hct | 37.6% | 14.5% | 0.258 |
| PLT | 311,379 | 225,450 | 0.004 |
| INR | 0.957 | 1.004 | 0.008 |
| aPTT | 27.215 | 32.020 | <0.001 |
| Fibrinogen | 447.84 | 319.45 | 0.202 |
| CD146 | 0.198 | 0.199 | 0.876 |
| p-Selectin | 0.405 | 0.400 | 0.753 |
| u-PA | 0.174 | 0.086 | 0.011 |
| u-PA-R | 0.969 | 0.763 | 0.001 |
| CT | 434.03 | 499.45 | 0.003 |
| CFT | 101.00 | 133.45 | <0.001 |
| MCF | 65.67 | 58.80 | <0.001 |
| ALPHA | 70.61 | 64.45 | <0.001 |
| LI60 | 95.24 | 95.35 | 0.832 |
Conclusions
ROTEM measurements reflect a significant hypercoagulability in cancer pts when compared to healthy individuals. Our analysis does not identify any predictive factor for progression or death. However, specific ROTEM parameters could be incorporated into a risk assessment model for TEE in cancer pts.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.