Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery

Casey J. Allen, Charles A. Karcutskie, Laura Zebib, Gerardo A. Guarch, Mena M. Hanna, Jonathan P. Meizoso, Juliet J. Ray, Morad Askari, Seth Thaller, Kenneth G Proctor

Research output: Contribution to journalArticle

Abstract

Background: This study assessed hemostatic function in cancer patients at high risk for venous thromboembolism. Methods: Thirty-eight female patients (age, 53 ± 9 years) undergoing immediate postmastectomy reconstruction were prospectively studied with informed consent. Blood was sampled preoperatively, on postoperative day 1, and at 1 week follow-up. Rotational thromboelastography clotting time, α-angle (clot kinetics), clot formation time, and maximum clot firmness were studied with three different activating agents: intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. Thromboprophylaxis was unfractionated heparin plus sequential compression devices if not contraindicated. Hypercoagulability was defined by one or more parameters outside the reference range. Results: Preoperatively, 29 percent of patients were hypercoagulable, increasing to 67 percent by week 1 (p = 0.017). Clotting time, clot formation time, and α-angle remained relatively constant over time, but maximum clot formation increased in intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (all p < 0.05). Body mass index was 28 ± 5 kg/m2, 23 percent received preoperative chemotherapy, and 15 percent had a history of tobacco use, but there was no association between these risk factors and hypercoagulability. Conclusions: Despite perioperative thromboprophylaxis, two-thirds of patients undergoing combined tumor resection and reconstructive surgery for breast cancer were hypercoagulable 1 week after surgery. Hypercoagulability was associated with increased clot strength mediated by changes in platelet and fibrin function.

Original languageEnglish (US)
Pages (from-to)923e-930e
JournalPlastic and Reconstructive Surgery
Volume137
Issue number6
DOIs
StatePublished - Jun 1 2016

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Reconstructive Surgical Procedures
Thromboplastin
Breast
Thrombophilia
Fibrin
Ellagic Acid
Cytochalasin D
Platelet Aggregation Inhibitors
Thrombelastography
Venous Thromboembolism
Tobacco Use
Hemostatics
Informed Consent
Heparin
Neoplasms
Reference Values
Body Mass Index
Blood Platelets
Breast Neoplasms
Drug Therapy

ASJC Scopus subject areas

  • Surgery

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Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery. / Allen, Casey J.; Karcutskie, Charles A.; Zebib, Laura; Guarch, Gerardo A.; Hanna, Mena M.; Meizoso, Jonathan P.; Ray, Juliet J.; Askari, Morad; Thaller, Seth; Proctor, Kenneth G.

In: Plastic and Reconstructive Surgery, Vol. 137, No. 6, 01.06.2016, p. 923e-930e.

Research output: Contribution to journalArticle

Allen, CJ, Karcutskie, CA, Zebib, L, Guarch, GA, Hanna, MM, Meizoso, JP, Ray, JJ, Askari, M, Thaller, S & Proctor, KG 2016, 'Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery', Plastic and Reconstructive Surgery, vol. 137, no. 6, pp. 923e-930e. https://doi.org/10.1097/PRS.0000000000002177
Allen CJ, Karcutskie CA, Zebib L, Guarch GA, Hanna MM, Meizoso JP et al. Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery. Plastic and Reconstructive Surgery. 2016 Jun 1;137(6):923e-930e. https://doi.org/10.1097/PRS.0000000000002177
Allen, Casey J. ; Karcutskie, Charles A. ; Zebib, Laura ; Guarch, Gerardo A. ; Hanna, Mena M. ; Meizoso, Jonathan P. ; Ray, Juliet J. ; Askari, Morad ; Thaller, Seth ; Proctor, Kenneth G. / Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery. In: Plastic and Reconstructive Surgery. 2016 ; Vol. 137, No. 6. pp. 923e-930e.
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abstract = "Background: This study assessed hemostatic function in cancer patients at high risk for venous thromboembolism. Methods: Thirty-eight female patients (age, 53 ± 9 years) undergoing immediate postmastectomy reconstruction were prospectively studied with informed consent. Blood was sampled preoperatively, on postoperative day 1, and at 1 week follow-up. Rotational thromboelastography clotting time, α-angle (clot kinetics), clot formation time, and maximum clot firmness were studied with three different activating agents: intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. Thromboprophylaxis was unfractionated heparin plus sequential compression devices if not contraindicated. Hypercoagulability was defined by one or more parameters outside the reference range. Results: Preoperatively, 29 percent of patients were hypercoagulable, increasing to 67 percent by week 1 (p = 0.017). Clotting time, clot formation time, and α-angle remained relatively constant over time, but maximum clot formation increased in intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (all p < 0.05). Body mass index was 28 ± 5 kg/m2, 23 percent received preoperative chemotherapy, and 15 percent had a history of tobacco use, but there was no association between these risk factors and hypercoagulability. Conclusions: Despite perioperative thromboprophylaxis, two-thirds of patients undergoing combined tumor resection and reconstructive surgery for breast cancer were hypercoagulable 1 week after surgery. Hypercoagulability was associated with increased clot strength mediated by changes in platelet and fibrin function.",
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AU - Karcutskie, Charles A.

AU - Zebib, Laura

AU - Guarch, Gerardo A.

AU - Hanna, Mena M.

AU - Meizoso, Jonathan P.

AU - Ray, Juliet J.

AU - Askari, Morad

AU - Thaller, Seth

AU - Proctor, Kenneth G

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N2 - Background: This study assessed hemostatic function in cancer patients at high risk for venous thromboembolism. Methods: Thirty-eight female patients (age, 53 ± 9 years) undergoing immediate postmastectomy reconstruction were prospectively studied with informed consent. Blood was sampled preoperatively, on postoperative day 1, and at 1 week follow-up. Rotational thromboelastography clotting time, α-angle (clot kinetics), clot formation time, and maximum clot firmness were studied with three different activating agents: intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. Thromboprophylaxis was unfractionated heparin plus sequential compression devices if not contraindicated. Hypercoagulability was defined by one or more parameters outside the reference range. Results: Preoperatively, 29 percent of patients were hypercoagulable, increasing to 67 percent by week 1 (p = 0.017). Clotting time, clot formation time, and α-angle remained relatively constant over time, but maximum clot formation increased in intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (all p < 0.05). Body mass index was 28 ± 5 kg/m2, 23 percent received preoperative chemotherapy, and 15 percent had a history of tobacco use, but there was no association between these risk factors and hypercoagulability. Conclusions: Despite perioperative thromboprophylaxis, two-thirds of patients undergoing combined tumor resection and reconstructive surgery for breast cancer were hypercoagulable 1 week after surgery. Hypercoagulability was associated with increased clot strength mediated by changes in platelet and fibrin function.

AB - Background: This study assessed hemostatic function in cancer patients at high risk for venous thromboembolism. Methods: Thirty-eight female patients (age, 53 ± 9 years) undergoing immediate postmastectomy reconstruction were prospectively studied with informed consent. Blood was sampled preoperatively, on postoperative day 1, and at 1 week follow-up. Rotational thromboelastography clotting time, α-angle (clot kinetics), clot formation time, and maximum clot firmness were studied with three different activating agents: intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. Thromboprophylaxis was unfractionated heparin plus sequential compression devices if not contraindicated. Hypercoagulability was defined by one or more parameters outside the reference range. Results: Preoperatively, 29 percent of patients were hypercoagulable, increasing to 67 percent by week 1 (p = 0.017). Clotting time, clot formation time, and α-angle remained relatively constant over time, but maximum clot formation increased in intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (all p < 0.05). Body mass index was 28 ± 5 kg/m2, 23 percent received preoperative chemotherapy, and 15 percent had a history of tobacco use, but there was no association between these risk factors and hypercoagulability. Conclusions: Despite perioperative thromboprophylaxis, two-thirds of patients undergoing combined tumor resection and reconstructive surgery for breast cancer were hypercoagulable 1 week after surgery. Hypercoagulability was associated with increased clot strength mediated by changes in platelet and fibrin function.

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