Pre-existing hypercoagulability in patients undergoing potentially curative cancer resection

Chad M. Thorson, Robert M. Van Haren, Mark L. Ryan, Emiliano Curia, Danny Sleeman, Joe Levi, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background. Rotational thromboelastometry (ROTEM) is a new point-of-care test that allows a rapid and comprehensive evaluation of coagulation. We were among the first to show that ROTEM identifies baseline hypercoagulability in 40% of patients with intra-abdominal malignancies and that hypercoagulability persists for ≥1 month after resection. The purpose of this follow-up study was to confirm and extend these observations to a larger population in outpatient preoperative clinics. The hypothesis is that pre-existing hypercoagulability is present in patients undergoing surgery for malignant disease and that coagulation status varies by tumor type. Methods. After informed consent, preoperative blood samples were drawn from patients undergoing exploratory laparotomies for intra-abdominal malignancies and analyzed with ROTEM. Results. Eighty-two patients were enrolled, including 72 with a confirmed pathologic diagnosis and 10 age-matched controls with benign disease. The most common cancers involved the pancreas (n = 23; 32%), esophagus (n = 19; 26%), liver (n = 12; 17%), stomach (n = 7; 10%), and bile ducts (n = 5; 7%). Preoperative hypercoagulability was detected in 31% (n = 22); these patients were more likely to have lymphovascular invasion (88% vs 50%; P = .011), perineural invasion (77% vs 36%; P = .007), and stage III/IV disease (80% vs 62%; P = .039). More patients with pancreatic tumors (9/23, 39%) were hypercoagulable than with esophageal (3/19, 16%) or liver (2/13, 15%, P = .034) tumors. When only resectable malignancies were considered, clot formation was more rapid (low clot formation time, high alpha) with enhanced maximum clot strength (high maximum clot firmness) in pancreatic versus esophageal or liver cancers and in all cancers versus those with benign disease. Conclusion. Preoperative hypercoagulability can be identified with ROTEM and is associated with lymphovascular/perineural invasion and advanced-staged disease in cancer. Compared with other tumor types, pancreatic adenocarcinomas have the greatest risk for hypercoagulability.

Original languageEnglish
Pages (from-to)134-144
Number of pages11
JournalSurgery (United States)
Volume155
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Thrombophilia
Thrombelastography
Neoplasms
Point-of-Care Systems
Liver
Liver Neoplasms
Esophageal Neoplasms
Ambulatory Care Facilities
Bile Ducts
Informed Consent
Pancreatic Neoplasms
Laparotomy
Esophagus
Stomach
Adenocarcinoma

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Pre-existing hypercoagulability in patients undergoing potentially curative cancer resection. / Thorson, Chad M.; Van Haren, Robert M.; Ryan, Mark L.; Curia, Emiliano; Sleeman, Danny; Levi, Joe; Livingstone, Alan; Proctor, Kenneth G.

In: Surgery (United States), Vol. 155, No. 1, 01.01.2014, p. 134-144.

Research output: Contribution to journalArticle

Thorson, Chad M. ; Van Haren, Robert M. ; Ryan, Mark L. ; Curia, Emiliano ; Sleeman, Danny ; Levi, Joe ; Livingstone, Alan ; Proctor, Kenneth G. / Pre-existing hypercoagulability in patients undergoing potentially curative cancer resection. In: Surgery (United States). 2014 ; Vol. 155, No. 1. pp. 134-144.
@article{a03e69fa432a46b09f64faedd43f04f7,
title = "Pre-existing hypercoagulability in patients undergoing potentially curative cancer resection",
abstract = "Background. Rotational thromboelastometry (ROTEM) is a new point-of-care test that allows a rapid and comprehensive evaluation of coagulation. We were among the first to show that ROTEM identifies baseline hypercoagulability in 40{\%} of patients with intra-abdominal malignancies and that hypercoagulability persists for ≥1 month after resection. The purpose of this follow-up study was to confirm and extend these observations to a larger population in outpatient preoperative clinics. The hypothesis is that pre-existing hypercoagulability is present in patients undergoing surgery for malignant disease and that coagulation status varies by tumor type. Methods. After informed consent, preoperative blood samples were drawn from patients undergoing exploratory laparotomies for intra-abdominal malignancies and analyzed with ROTEM. Results. Eighty-two patients were enrolled, including 72 with a confirmed pathologic diagnosis and 10 age-matched controls with benign disease. The most common cancers involved the pancreas (n = 23; 32{\%}), esophagus (n = 19; 26{\%}), liver (n = 12; 17{\%}), stomach (n = 7; 10{\%}), and bile ducts (n = 5; 7{\%}). Preoperative hypercoagulability was detected in 31{\%} (n = 22); these patients were more likely to have lymphovascular invasion (88{\%} vs 50{\%}; P = .011), perineural invasion (77{\%} vs 36{\%}; P = .007), and stage III/IV disease (80{\%} vs 62{\%}; P = .039). More patients with pancreatic tumors (9/23, 39{\%}) were hypercoagulable than with esophageal (3/19, 16{\%}) or liver (2/13, 15{\%}, P = .034) tumors. When only resectable malignancies were considered, clot formation was more rapid (low clot formation time, high alpha) with enhanced maximum clot strength (high maximum clot firmness) in pancreatic versus esophageal or liver cancers and in all cancers versus those with benign disease. Conclusion. Preoperative hypercoagulability can be identified with ROTEM and is associated with lymphovascular/perineural invasion and advanced-staged disease in cancer. Compared with other tumor types, pancreatic adenocarcinomas have the greatest risk for hypercoagulability.",
author = "Thorson, {Chad M.} and {Van Haren}, {Robert M.} and Ryan, {Mark L.} and Emiliano Curia and Danny Sleeman and Joe Levi and Alan Livingstone and Proctor, {Kenneth G}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.surg.2013.06.053",
language = "English",
volume = "155",
pages = "134--144",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Pre-existing hypercoagulability in patients undergoing potentially curative cancer resection

AU - Thorson, Chad M.

AU - Van Haren, Robert M.

AU - Ryan, Mark L.

AU - Curia, Emiliano

AU - Sleeman, Danny

AU - Levi, Joe

AU - Livingstone, Alan

AU - Proctor, Kenneth G

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background. Rotational thromboelastometry (ROTEM) is a new point-of-care test that allows a rapid and comprehensive evaluation of coagulation. We were among the first to show that ROTEM identifies baseline hypercoagulability in 40% of patients with intra-abdominal malignancies and that hypercoagulability persists for ≥1 month after resection. The purpose of this follow-up study was to confirm and extend these observations to a larger population in outpatient preoperative clinics. The hypothesis is that pre-existing hypercoagulability is present in patients undergoing surgery for malignant disease and that coagulation status varies by tumor type. Methods. After informed consent, preoperative blood samples were drawn from patients undergoing exploratory laparotomies for intra-abdominal malignancies and analyzed with ROTEM. Results. Eighty-two patients were enrolled, including 72 with a confirmed pathologic diagnosis and 10 age-matched controls with benign disease. The most common cancers involved the pancreas (n = 23; 32%), esophagus (n = 19; 26%), liver (n = 12; 17%), stomach (n = 7; 10%), and bile ducts (n = 5; 7%). Preoperative hypercoagulability was detected in 31% (n = 22); these patients were more likely to have lymphovascular invasion (88% vs 50%; P = .011), perineural invasion (77% vs 36%; P = .007), and stage III/IV disease (80% vs 62%; P = .039). More patients with pancreatic tumors (9/23, 39%) were hypercoagulable than with esophageal (3/19, 16%) or liver (2/13, 15%, P = .034) tumors. When only resectable malignancies were considered, clot formation was more rapid (low clot formation time, high alpha) with enhanced maximum clot strength (high maximum clot firmness) in pancreatic versus esophageal or liver cancers and in all cancers versus those with benign disease. Conclusion. Preoperative hypercoagulability can be identified with ROTEM and is associated with lymphovascular/perineural invasion and advanced-staged disease in cancer. Compared with other tumor types, pancreatic adenocarcinomas have the greatest risk for hypercoagulability.

AB - Background. Rotational thromboelastometry (ROTEM) is a new point-of-care test that allows a rapid and comprehensive evaluation of coagulation. We were among the first to show that ROTEM identifies baseline hypercoagulability in 40% of patients with intra-abdominal malignancies and that hypercoagulability persists for ≥1 month after resection. The purpose of this follow-up study was to confirm and extend these observations to a larger population in outpatient preoperative clinics. The hypothesis is that pre-existing hypercoagulability is present in patients undergoing surgery for malignant disease and that coagulation status varies by tumor type. Methods. After informed consent, preoperative blood samples were drawn from patients undergoing exploratory laparotomies for intra-abdominal malignancies and analyzed with ROTEM. Results. Eighty-two patients were enrolled, including 72 with a confirmed pathologic diagnosis and 10 age-matched controls with benign disease. The most common cancers involved the pancreas (n = 23; 32%), esophagus (n = 19; 26%), liver (n = 12; 17%), stomach (n = 7; 10%), and bile ducts (n = 5; 7%). Preoperative hypercoagulability was detected in 31% (n = 22); these patients were more likely to have lymphovascular invasion (88% vs 50%; P = .011), perineural invasion (77% vs 36%; P = .007), and stage III/IV disease (80% vs 62%; P = .039). More patients with pancreatic tumors (9/23, 39%) were hypercoagulable than with esophageal (3/19, 16%) or liver (2/13, 15%, P = .034) tumors. When only resectable malignancies were considered, clot formation was more rapid (low clot formation time, high alpha) with enhanced maximum clot strength (high maximum clot firmness) in pancreatic versus esophageal or liver cancers and in all cancers versus those with benign disease. Conclusion. Preoperative hypercoagulability can be identified with ROTEM and is associated with lymphovascular/perineural invasion and advanced-staged disease in cancer. Compared with other tumor types, pancreatic adenocarcinomas have the greatest risk for hypercoagulability.

UR - http://www.scopus.com/inward/record.url?scp=84896457457&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896457457&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2013.06.053

DO - 10.1016/j.surg.2013.06.053

M3 - Article

VL - 155

SP - 134

EP - 144

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 1

ER -