Department of Hematology, Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Center+, Maastricht, the Netherlands.
J Thromb Haemost. 2019 Jul;17(7):1073-1084. doi: 10.1111/jth.14465. Epub 2019 May 24.
Essentials Bleeding in chemotherapy induced thrombocytopenia (CIT) might be influenced by hyperfibrinolysis. t-PA-thromboelastography is a fast and reliable assay for hyperfibrinolysis in CIT patients. Clots of CIT patients are more susceptible to t-PA induced lysis compared to healthy individuals. Besides platelets, other factors are likely to influence clot lysis in CIT patients.
Bleeding events in chemotherapy-induced thrombocytopenic (CIT) patients with similar platelet counts might be influenced by changes in clot lysis potential.
To investigate, in an observational study, thromboelastographic lysis parameters, alterations in clot strength and susceptibility to clot lysis in CIT patients. To identify factors associated with fibrinolytic profiles, and to evaluate the effects of platelet transfusions.
Independent determinants of tissue-type plasminogen activator (t-PA)-ROTEM lysis parameters were identified with multivariable linear regression. Clot formation, strength and lysis parameters were compared with the results of healthy individuals. Characteristics of CIT patients with and without hyperfibrinolytic profiles were compared. t-PA-ROTEM results before, 1 hour after and 24 hours after platelet transfusion were compared.
A total of 72 consecutive CIT patients were included. t-PA-ROTEM lysis parameters correlated with changes in fibrinolytic proteins. Clot formation time was longer, maximum clot firmness was weaker and lysis times were shorter than in healthy individuals. CIT patients had low plasminogen activator inhibitor-1 and thrombin-activatable fibrinolysis inhibitor levels, and 40% showed hyperfibrinolytic profiles. Platelet transfusions resulted in less hyperfibrinolytic profiles in many, but not all CIT patients. Patients without hyperfibrinolytic profiles had higher fibrinogen, factor VIII and α -antiplasmin levels.
t-PA-ROTEM can be used as a fast and reliable assay to detect hyperfibrinolytic profiles in CIT patients. CIT patients have weaker clots, which are more susceptible to clot lysis, than healthy individuals. Besides platelets, other factors are likely to influence clot susceptibility to fibrinolysis in CIT patients. The impact of a hyperfibrinolytic t-PA-ROTEM profile on bleeding remains to be investigated.
在一项观察性研究中，研究化疗诱导性血小板减少症（CIT）患者血栓弹性图（TEG）的纤溶相关参数、血栓强度和纤溶倾向的变化，并确定与纤维蛋白溶解谱相关的因素，以及评估血小板输注的影响。
采用多变量线性回归确定组织型纤溶酶原激活物（t-PA）-ROTEM 纤溶参数的独立决定因素。比较 CIT 患者与健康个体的血栓形成、强度和纤溶参数。比较有和无高纤维蛋白溶解谱的 CIT 患者的特征。比较血小板输注前、输注后 1 小时和输注后 24 小时的 t-PA-ROTEM 结果。
共纳入 72 例连续 CIT 患者。t-PA-ROTEM 纤溶参数与纤溶蛋白的变化相关。与健康个体相比，CIT 患者的血栓形成时间较长，最大血栓硬度较弱，纤溶时间较短。CIT 患者的纤溶酶原激活物抑制剂-1 和凝血酶激活的纤溶抑制剂水平较低，40%的患者存在高纤维蛋白溶解谱。在许多但不是所有的 CIT 患者中，血小板输注导致较少的高纤维蛋白溶解谱。无高纤维蛋白溶解谱的患者的纤维蛋白原、因子 VIII 和α-抗纤溶酶水平较高。
t-PA-ROTEM 可作为一种快速可靠的方法，用于检测 CIT 患者的高纤维蛋白溶解谱。与健康个体相比，CIT 患者的血栓较弱，更容易发生纤溶。除了血小板，其他因素也可能影响 CIT 患者血栓对纤溶的敏感性。高纤维蛋白溶解 t-PA-ROTEM 谱对出血的影响仍有待研究。
