Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Department of Urology, Queen's University, Kingston, Ontario, Canada.
Thromb Res. 2014 Jan;133(1):88-95. doi: 10.1016/j.thromres.2013.10.007. Epub 2013 Oct 12.
Cancer patients are at higher risk for thromboembolism compared to the normal population. This may be related to tumour burden and/or enhanced by systemic therapy. While there is ample evidence regarding venous thromboembolism, systematic studies investigating arterial thrombotic events are scarce. Conventional coagulation tests have limited capacity in evaluating the coagulability or the need for anticoagulant prophylaxis. In this pilot study, we investigated whether assessment of global haemostasis using thromboelastography (TEG) and quantification of plasma pro-coagulant microparticles can help determine the risk of adverse thrombotic events in patients with prostate cancer (PCa). Thirty two patients were recruited a priori into three groups: 11 men on 'watchful waiting' following recurrent disease after definitive treatment (Group A); 10 patients with metastatic disease on Androgen deprivation therapy (ADT) (Group B); and 11 with castration resistant cancer (Group C) and followed up over a period of 12months. These patients were compared to a control group composed of 8 men with negative prostate biopsy. Whole blood TEG and plasma tissue factor-carrying microparticles (TF-MPs) in addition to basic coagulation testing, plasma fibrinogen and d-dimer were performed. 22/32 (68.8%) of the patients demonstrated hypercoagulable TEG traces. Hypercoagulability was marked in group B compared to the control. Plasma MPs were significantly elevated in patients compared to the controls with significant increase in group B. All other coagulation tests were normal. Seven of the 22 hypercoagulable patients (31.8%) developed one or more thromboembolic events over 12months follow up period. The data in this pilot study show that PCa patients are hypercoagulable, particularly those with advanced disease on ADT and that this hypercoagulability can be identified by TEG. While this needs to be verified in a larger study, the data indicate TEG may aid in thrombosis risk stratification and determining the subsequent need for anticoagulant prophylaxis in PCa patients.
与普通人群相比，癌症患者发生血栓栓塞的风险更高。这可能与肿瘤负担有关，也可能因全身治疗而加重。虽然静脉血栓栓塞的证据充足，但系统研究动脉血栓性事件的研究却很少。常规凝血试验在评估凝血能力或抗凝预防的必要性方面能力有限。在这项初步研究中，我们研究了使用血栓弹力图（TEG）评估整体止血功能和定量检测血浆促凝血微粒是否有助于确定前列腺癌（PCa）患者发生不良血栓事件的风险。32 名患者被预先分为三组：11 名在根治性治疗后疾病复发的“观察等待”患者（A 组）；10 名接受雄激素剥夺治疗（ADT）的转移性疾病患者（B 组）；11 名接受去势抵抗性癌症治疗（C 组），并随访 12 个月。将这些患者与由 8 名前列腺活检阴性的男性组成的对照组进行比较。进行全血 TEG 和携带组织因子的微粒（TF-MPs）检测，以及基本凝血检测、血浆纤维蛋白原和 D-二聚体。32 名患者中有 22 名（68.8%）的 TEG 检测结果显示高凝状态。与对照组相比，B 组的高凝状态更为明显。与对照组相比，患者的血浆微粒明显升高，且 B 组的升高更为显著。其他所有凝血试验均正常。22 名高凝患者中有 7 名（31.8%）在 12 个月的随访期间发生了 1 次或多次血栓栓塞事件。这项初步研究的数据表明，PCa 患者存在高凝状态，尤其是接受 ADT 治疗的晚期疾病患者，而 TEG 可识别这种高凝状态。虽然这需要在更大的研究中得到验证，但数据表明 TEG 可能有助于对 PCa 患者进行血栓风险分层，并确定随后抗凝预防的必要性。
