Hypercoagulability After Resection of Thoracic Malignancy: A Prospective Evaluation

Michelle B. Mulder, Kenneth G. Proctor, Evan J. Valle, Alan S. Livingstone, Dao M. Nguyen, Robert M. Van Haren

Research output: Contribution to journalArticle

Abstract

Background: Rates of venous thromboembolism are increased in thoracic malignancy; however, coagulation patterns are not established. We hypothesize that patients with esophageal and lung malignancy have similar hypercoagulable pre- and postoperative profiles as defined by rotational thromboelastometry (ROTEM). Methods: Prospective study was conducted in 47 patients with esophageal and lung cancer undergoing surgical resection. ROTEM evaluated pre/postoperative coagulation status. Results: Patients with thoracic malignancy were hypercoagulable by ROTEM, but not by conventional coagulation tests. Preoperative hypercoagulability was higher in lung versus esophageal cancer (64 vs. 16%, p = 0.001). Lung cancer patients that were hypercoagulable preoperatively demonstrated decreased maximum clot firmness (MCF) (p = 0.044) and increased clot time (p = 0.049) after surgical resection, suggesting reversal of hypercoagulability. Resection of esophageal cancer increased hypercoagulability (16 vs. 56%, p = 0.002) via elevated MCF (reflecting platelet activity). Hypercoagulability remained at follow-up clinic for both lung and esophageal cancer patients. Conclusions: Hypercoagulability in patients with lung malignancies reversed following complete surgical resection, whereas hypercoagulability occurred only postoperatively in those with esophageal malignancies. In both, hypercoagulability was associated with fibrin and platelet function.

Original languageEnglish (US)
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Thrombophilia
Thorax
Esophageal Neoplasms
Thrombelastography
Neoplasms
Lung Neoplasms
Lung
Blood Platelets
Venous Thromboembolism
Fibrin
Prospective Studies

ASJC Scopus subject areas

  • Surgery

Cite this

Hypercoagulability After Resection of Thoracic Malignancy : A Prospective Evaluation. / Mulder, Michelle B.; Proctor, Kenneth G.; Valle, Evan J.; Livingstone, Alan S.; Nguyen, Dao M.; Van Haren, Robert M.

In: World Journal of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Rates of venous thromboembolism are increased in thoracic malignancy; however, coagulation patterns are not established. We hypothesize that patients with esophageal and lung malignancy have similar hypercoagulable pre- and postoperative profiles as defined by rotational thromboelastometry (ROTEM). Methods: Prospective study was conducted in 47 patients with esophageal and lung cancer undergoing surgical resection. ROTEM evaluated pre/postoperative coagulation status. Results: Patients with thoracic malignancy were hypercoagulable by ROTEM, but not by conventional coagulation tests. Preoperative hypercoagulability was higher in lung versus esophageal cancer (64 vs. 16{\%}, p = 0.001). Lung cancer patients that were hypercoagulable preoperatively demonstrated decreased maximum clot firmness (MCF) (p = 0.044) and increased clot time (p = 0.049) after surgical resection, suggesting reversal of hypercoagulability. Resection of esophageal cancer increased hypercoagulability (16 vs. 56{\%}, p = 0.002) via elevated MCF (reflecting platelet activity). Hypercoagulability remained at follow-up clinic for both lung and esophageal cancer patients. Conclusions: Hypercoagulability in patients with lung malignancies reversed following complete surgical resection, whereas hypercoagulability occurred only postoperatively in those with esophageal malignancies. In both, hypercoagulability was associated with fibrin and platelet function.",
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