Tsantes Andreas G, Loukopoulou Ilectra, Papadopoulos Dimitrios V, Trikoupis Ioannis G, Roustemis Anastasios G, Goumenos Stavros, Sokou Rozeta, Tsante Konstantina A, Kriebardis Anastasios G, Koulouvaris Panagiotis, Houhoula Dimitra, Piovani Daniele, Papagelopoulos Panayiotis J, Bonovas Stefanos, Tsantes Argirios E
Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece.
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
Cancers (Basel). 2022 Aug 15;14(16):3930. doi: 10.3390/cancers14163930.
Introduction: A detailed evaluation of the malignancy-associated coagulopathy (MAC) in surgical patients with bone tumors may allow for more effective thromboprophylactic measures. The purpose of this study was to assess the perioperative hemostatic changes in patients with bone tumors, using rotational thromboelastometry (ROTEM). Methods: An observational study was performed, including 50 patients with bone tumors who underwent oncologic resection and 30 healthy controls, matched for age and gender. The preoperative and postoperative laboratory evaluation of coagulation in both groups included conventional coagulation tests and a ROTEM analysis. The results of the conventional coagulation tests and the ROTEM analysis were compared between the two groups. Results: The results of the conventional coagulation tests were comparable between the tumor patients and the healthy controls. However, compared to the healthy adults, the tumor patients had lower CT (p < 0.001) and CFT (p < 0.001) values suggesting a rapid induction of the coagulation cascade, elevated A10 (p < 0.001) and MCF (p < 0.001) values indicating a higher clot strength and platelet activation, and elevated LI60 (p < 0.001) values indicating hypofibrinolysis in patients with bone tumors. The multiple linear regression analysis (controlling for potential confounding factors) confirmed the independent association of bone tumors with these hemostatic changes. Conclusions: Our results support the advantageous use of a ROTEM in patients with bone tumors over conventional coagulation tests because the qualitative changes in the hemostatic profile of these patients that can be detected by a ROTEM analysis cannot be identified by conventional tests. The ROTEM results indicate that the hypercoagulable state in patients with bone tumors is caused by the malignancy-associated activation of the coagulation cascade, platelet activation, and hypofibrinolysis.
对骨肿瘤手术患者的恶性肿瘤相关凝血病（MAC）进行详细评估，可能有助于采取更有效的血栓预防措施。本研究的目的是使用旋转血栓弹力图（ROTEM）评估骨肿瘤患者围手术期的止血变化。方法：进行了一项观察性研究，纳入50例行肿瘤切除术的骨肿瘤患者和30名年龄和性别匹配的健康对照者。两组患者术前和术后的凝血实验室评估包括传统凝血试验和ROTEM分析。比较两组的传统凝血试验结果和ROTEM分析结果。结果：肿瘤患者和健康对照者的传统凝血试验结果具有可比性。然而，与健康成年人相比，肿瘤患者的CT（p < 0.001）和CFT（p < 0.001）值较低，提示凝血级联反应快速启动；A10（p < 0.001）和MCF（p < 0.001）值升高，表明凝血强度和血小板活化较高；LI60（p < 0.001）值升高，表明骨肿瘤患者存在纤维蛋白溶解功能减退。多元线性回归分析（控制潜在混杂因素）证实骨肿瘤与这些止血变化存在独立关联。结论：我们的结果支持在骨肿瘤患者中使用ROTEM优于传统凝血试验，因为传统试验无法识别ROTEM分析所能检测到的这些患者止血特征的定性变化。ROTEM结果表明，骨肿瘤患者的高凝状态是由恶性肿瘤相关的凝血级联反应激活、血小板活化和纤维蛋白溶解功能减退引起的。
