Presentation Details
| Using a thrombodynamics test for diagnostics of hypercoagulation in cancer patients and prediction of thromboembolic complications: preliminary research results. Irina Dudina1, Ekaterina Koltsova2, 3, Irina Nigmatullina1, Yana Akhmadiyarova1, Olga Kostash1, Anna Chankina1, Daniil Stroyakovskiy1. 1State Budgetary Healthcare Institution Moscow City Oncology Hospital No.62 of the Moscow City Health Department, Russian Federation, Moscow, 143515, Moskovskaya area, Krasnogorsk urban district, Istra village, building 27, Moscow, Russia.2Federal State Budgetary Institution Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Health of the Russian Federation, Russian Federation, Moscow, 117198, Samory Machel street, building 1, Moscow, Russia.3Federal State Budgetary Institution of Science Center for Theoretical Problems of Physico-Chemical Pharmacology, Russian Academy of Sciences, Russian Federation, Moscow, 109029, Srednyaya Kalitnikovskaya street, building 30, Moscow, Russia |
Abstract
Background. Venous thromboembolism complications (VTE) are the second most common cause of death in cancer patients. The Khorana score is used for risk stratification of VTE complications, although its sensitivity, according to world literature, is only 22% while its specificity is 82%. Objectives. This article presents preliminary results of a monocentric observational study which was aimed at the assessment of the effectiveness of a global hemostasis test, thrombodynamics, for the diagnostics of hypercoagulation in cancer patients and prediction of VTE complications. Methods. The interim analysis included 269 patients. The observation median value was 4.3 months. Blood tests for thrombodynamics were conducted using a thrombodynamics analyser (ООО HemaCore, Russia). The statistical analysis was conducted using the Mann–Whitney U test (unconjugated samples) and the Wilcoxon signed-rank test (conjugated samples). The results were considered significant with р<0.05. ROC analysis was used to assess the sensitivity of the thrombodynamics test results. Results. Blood coagulation in oncological patients was characterised by the presence of pronounced hypercoagulation in 90% of the patients, according to the test results. The median number of study points (blood sampling for thrombodynamics analysis) was 6 (1-38), the median follow-up period was 4.3 months. According to the parameters of thrombodynamics it was concluded that the parameter Tlag, characterizing the starting phase of clot growth, was within the normal range in the majority of patients, while the velocity parameters of thrombodynamics Vi and V were shifted towards hypercoagulation in 80-90% of patients included in the study. Moreover, the severity of hypercoagulability by Vi and V parameters statistically significantly decreased from 1 blood collection, which corresponded to the 1st course of chemotherapy, to the 5th blood collection - in 2.5-3 months from the beginning of chemotherapy. Also, 36-61% of the observed hypercoagulability was accompanied by the formation of spontaneous clots. Once the antineoplastic therapy was initiated, hypercoagulation tended to decrease. With a median value of 4.3 months, hypercoagulation resulted in VTE complications in 14% of patients. The Khorana score points were not reliable in this patient cohort. ROC analysis of the thrombodynamics data showed that the parameter value of V higher than 40.7 µm/min is an accurate predictor of a thromboembolic event allowing to classify groups with sensitivity of 60% and specificity of 78%. A relative risk of thrombosis calculated using this cut-off was 2.7 (95%CI 1.6-4.7; p<0.001). Conclusion. Thrombodynamics is a promising method for predicting VTE complications. This method has demonstrated higher sensitivity (60%) and almost similar specificity (78%) as compared to the Khorana score. Using this test in clinical practice allows identifying a group of patients who have a high risk of VTE complications and are in need of a preventive anticoagulant therapy while their Khorana score points are not high. Key words: thromboembolism complications, cancer, thrombodynamics, Khorana score
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.