Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer

Background: Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor pro...

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Дата:	2007
Автори:	Papa, M.L., Capasso, F., Pudore, L., Torre, S., Mango, S., Russo, V., Delrio, P., Palaia, R., Ruffolo, F., d’Eufemia, M.D., De Lucia, D., Napolitano, M., Di Micco, P., Parisi, V.
Формат:	Стаття
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Опубліковано:	Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України 2007
Назва видання:	Experimental Oncology
Теми:	Original contributions
Онлайн доступ:	http://dspace.nbuv.gov.ua/handle/123456789/138581
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Цитувати:	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer / M.L. Papa, F. Capasso, L. Pudore, S. Torre, S. Mango, V. Russo, P. Delrio, R. Palaia, F. Ruffolo, M.D. d’Eufemia, D. De Lucia, M. Napolitano, P. Di Micco, V. Parisi // Experimental Oncology. — 2007. — Т. 29, № 2. — С. 111-115. — Бібліогр.: 26 назв. — англ.

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spelling	irk-123456789-1385812018-06-20T03:03:21Z Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer Papa, M.L. Capasso, F. Pudore, L. Torre, S. Mango, S. Russo, V. Delrio, P. Palaia, R. Ruffolo, F. d’Eufemia, M.D. De Lucia, D. Napolitano, M. Di Micco, P. Parisi, V. Original contributions Background: Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can’t reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood. Aim: Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM® thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients. Patients and Methods: Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45–79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The continuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation. Results: Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3–58.7), males 50 s (42–71.2) vs 51 s (42–59), p = 0.1210 / 53 s (42–74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62–100), p = 0.0128 / 80 s (59–124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9–82.5), males 63 mm (56–73.7) vs 69 mm (59–95.8), p = 0.9911 / 69 mm (53.6–90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3–49.5) males 18 mm / 100 s (11–27) vs 15 mm 100 s (11.8–22), p < 0.001 / 13 mm / 100 s (10–21.8), p < 0.001 in controls .The t-MaxVel was shortened in cancer patients: females 65 s (48.6–112.8), males 81 s (50.1–135.9) vs 115 s (56.8–166), p <0.001 / 115 s (59.8–180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100 (5511–8148), males 5984 mm 100 (5119-6899) vs 5778 mm 100 (4998–6655), p < 0.001 / 5662 mm 100 (4704–6385), p = 0.0105. Conclusion: Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery. Предпосылки исследования количественная оценка риска тромбоза, связанного со злокачественными заболеваниями и противоопухолевой терапией, обязательно включает в себя применение средств-антикоагулянтов, защищающих больного от развития венозной тромбоэмболии (VTE)и возможно п рогрессии заболевания . Тем не менее ни один из маркеров ак- тивации коагуляции не имеет прогностической ценности с точки зрения возможности возникновения тромбоза у каждого отдельно взятого пациента. Современные мето ды оценки свертывания крови не отража ют образование тромба винамике ; наоборот, метод тромбо эластографии дает возможность специфически оценить кинетику свертывания крови целом . Цель: определить, в какой мере активность коагуляции, определяемой методом тромбоэ ластометрии, отражает состояние гиперсвертываемости крови у больных онкологического профиля после хирургического вмешательства. Пациенты и м ды: обследованы 50 больных раком пищ еваритель ного тракта в дооп ерационный п ериод (27 женщин, 23 му жчины, средний возраст 61,5 года (45–79 лет) и 147 здоровых доноров (71 мужчина, 76 женщин). Применяли метод тромбоэластометрии , основанный на тромбоэластографии Гартерта, с использованием анализатора коагуляциифирмыROTEM. Текущие д анные о свертывании за 50 мин измерений представили в виде динамичных профилей вязкости при образовании сгустка крови. Результаты: стандартные параметры (перио д коагуляции (CT), перио д образования сгу стка (CFT), максимал ь ная п лот- ность сгустка (MCF)) больных онкологического п рофиля близки к контроль ным . CT у больных онкологического п рофиля составлял: у женщин — 50 с (38,3–58,7), у му жчин 50 (42–71,2) vs 51 (42–59), p = 0,1210/53 ( 42–74,8 ), p = 0,1975 в контрольной группе . CFT у таких пациентов составлял : у женщин — 72 ( 32–92,4 м жчин – 80 с (50,2–128,7) vs 78 (62–100), p = 0,0128 80 (59–124,4), p = 0,9384 в контрол ьной группе . MCF у больных онкологического п составлял: у женщин — 70 мм (59,9–82,5), у мужчин — 63 мм (56–73,7) vs 69 мм (59–95,8), p = 0,9911 / 69 мм (53,6–90), p = 0,0135 в контрол ьной группе. У женщинпоказатели вязкости крови MaxVel были выше, чем у му жчин . Показатели MaxVel повышены у таких пациентов : у женщин — 19 мм/100 с (14,3–49,5) у му жчин — 18 мм/100 (11–27 ) vs 15 мм / 100 (11,8–22), p < 0,001 / 13 мм / 100 с (10–21,8), p <0,001 в контрол ьной группе. ь t-MaxVel понижен у больных онкологического профиля: у женщин – 65 с (48,6–112,8) , у мужчин – 81 с (50,1–135,9) vs 115 с (56,8–166), p < 0,001 / 115 с (59,8–180,8), p = 0,0002 в контрольной группе. Показатель AUC у повышен у женщин — 6451 мм 100 (5511–8148), у мужчин — 5984 мм 100 (5119–6899) vs 5778 мм 100 (4998–6655), p < 0,001 / 5662 мм 100 (4704–6385), p = 0.0105. Выводы в отличие от других мето дов, измеря ющих вариации отдельных комп онентов системы крови, метод тромбо эластографии отражает текущийп рофиль образования сгу сткав режиме реаль ного времени является информативным споссобом оценки состояния гемостаза у онкологических больных. 2007 Article Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer / M.L. Papa, F. Capasso, L. Pudore, S. Torre, S. Mango, V. Russo, P. Delrio, R. Palaia, F. Ruffolo, M.D. d’Eufemia, D. De Lucia, M. Napolitano, P. Di Micco, V. Parisi // Experimental Oncology. — 2007. — Т. 29, № 2. — С. 111-115. — Бібліогр.: 26 назв. — англ. 1812-9269 http://dspace.nbuv.gov.ua/handle/123456789/138581 en Experimental Oncology Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
institution	Digital Library of Periodicals of National Academy of Sciences of Ukraine
collection	DSpace DC
language	English
topic	Original contributions Original contributions
spellingShingle	Original contributions Original contributions Papa, M.L. Capasso, F. Pudore, L. Torre, S. Mango, S. Russo, V. Delrio, P. Palaia, R. Ruffolo, F. d’Eufemia, M.D. De Lucia, D. Napolitano, M. Di Micco, P. Parisi, V. Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer Experimental Oncology
description	Background: Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can’t reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood. Aim: Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM® thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients. Patients and Methods: Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45–79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The continuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation. Results: Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3–58.7), males 50 s (42–71.2) vs 51 s (42–59), p = 0.1210 / 53 s (42–74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62–100), p = 0.0128 / 80 s (59–124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9–82.5), males 63 mm (56–73.7) vs 69 mm (59–95.8), p = 0.9911 / 69 mm (53.6–90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3–49.5) males 18 mm / 100 s (11–27) vs 15 mm 100 s (11.8–22), p < 0.001 / 13 mm / 100 s (10–21.8), p < 0.001 in controls .The t-MaxVel was shortened in cancer patients: females 65 s (48.6–112.8), males 81 s (50.1–135.9) vs 115 s (56.8–166), p <0.001 / 115 s (59.8–180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100 (5511–8148), males 5984 mm 100 (5119-6899) vs 5778 mm 100 (4998–6655), p < 0.001 / 5662 mm 100 (4704–6385), p = 0.0105. Conclusion: Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery.
format	Article
author	Papa, M.L. Capasso, F. Pudore, L. Torre, S. Mango, S. Russo, V. Delrio, P. Palaia, R. Ruffolo, F. d’Eufemia, M.D. De Lucia, D. Napolitano, M. Di Micco, P. Parisi, V.
author_facet	Papa, M.L. Capasso, F. Pudore, L. Torre, S. Mango, S. Russo, V. Delrio, P. Palaia, R. Ruffolo, F. d’Eufemia, M.D. De Lucia, D. Napolitano, M. Di Micco, P. Parisi, V.
author_sort	Papa, M.L.
title	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
title_short	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
title_full	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
title_fullStr	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
title_full_unstemmed	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
title_sort	thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer
publisher	Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
publishDate	2007
topic_facet	Original contributions
url	http://dspace.nbuv.gov.ua/handle/123456789/138581
citation_txt	Thromboelastographic profiles as a tool for thrombotic risk in digestive tract cancer / M.L. Papa, F. Capasso, L. Pudore, S. Torre, S. Mango, V. Russo, P. Delrio, R. Palaia, F. Ruffolo, M.D. d’Eufemia, D. De Lucia, M. Napolitano, P. Di Micco, V. Parisi // Experimental Oncology. — 2007. — Т. 29, № 2. — С. 111-115. — Бібліогр.: 26 назв. — англ.
series	Experimental Oncology
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fulltext	Experimental Oncology �� ne�� ne�� ne�� Veno�s thromboembolism �VTE�� is seven fold in- creased in patients with malignancy when compared to patients not affected by solid t�mors [�]. Malignancy ind�ces an acq�ired thrombophilic state [�]; therefore�� in almost all cancer patients a s�b clinical activation of blood coag�lation takes place�� even witho�t symptoms of thrombosis. The hypercoag�lable state in cancer arises mostly from the capacity of t�mo�r cells to ex- press and release specific procoag�lant activities like cancer procoag�lant �CPA�� and tiss�e factor �TF�� and to interact with the host’s endotheli�m�� platelets and monocytes-macrophages ind�cing a prothrombotic phenotype within these cells [3]. The association be- tween malignancy and VTE s�ch as the relationship between t�mor growth and coag�lation activation has been known since Tro�ssea�’s time [4]. Nowadays it is evident that the coag�lation system plays an important role in the biology of malignant t�mors: the activation of haemostasis ind�ces a contin�o�s formation and removal of fibrin which mediates the adhesion of t�mor cells to endotheli�m facilitating their migration thro�gh the tiss�es and contrib�ting to t�mor progression [�]. Re- cent st�dies have revealed a nonhaemostatic role of TF in generation of coag�lation proteases and s�bseq�ent activation of proteases activated receptors �PARs�� on vasc�lar cells. This TF dependent signaling contrib�tes to a variety of biological processes incl�ding inflamma- tion�� angiogenesis and metastasis [6]. The prothrombotic state of cancer patients is enhanced by therape�tic in- terventions�� s�ch as s�rgery�� chemotherapy�� hormone therapy�� radiotherapy and it is related to disease stage and to the site of origin of the primary t�mor: patients with haematological cancer have the highest risk of VTE�� followed by those with l�ng and gastrointestinal cancers [�� 6]. Therefore q�antification of the magnit�de of the thrombotic risk associated with malignancy and anti- cancer therapy is essential to �se anticoag�lant dr�gs which selectively interfere with haemostatic mechanisms probably protecting patients both from VTE and from t�mor progression [��]. St�dies on haemostatic system in cancer patients show an increase in clotting factors lev- els�� markers of thrombin and fibrin generation�� fibrynolitic proteins and thrombocytosis [8]. However�� none of the coag�lation activation markers has any predictive val�e ThromboelasTographic profiles as a Tool for ThromboTic risk in digesTive TracT cancer M.L. Papa1, F. Capasso1, L. Pudore1, S. Torre1, S. Mango1, V. Russo1, P. Delrio2, R. Palaia2, F. Ruffolo2, M.D. d’Eufemia3, D. De Lucia3, , M. Napolitano3, P. Di Micco4, V. Parisi2 1Laboratory of Haemostasis and Thrombosis, San Giovanni Bosco Hospital of Naples, Naples, Italy 2Division of Oncological Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Naples, Italy 3Pathology Division, Second University of Naples, Naples, Italy 4Fatebenefratelli Hospital of Naples, Naples, Italy Background: Quantification of the magnitude of thrombotic risk associated with malignancy and with anti-cancer therapy is indispensable to use anticoagulant drugs which selectively interfere with haemostatic mechanisms protecting patients from venous thromboembolism (VTE) and probably from tumor progression. However, none of activation coagulation markers has any predictive value for the occurrence of the thrombotic events in one individual patient. Current clotting methods can’t reveal the overall dynamic clot formation; in contrast thromboelastographic methods specifically assess overall coagulation kinetics and its strength in whole blood. Aim: Objective of study was to evaluate if the activation of coagulation as eventually revealed by ROTEM® thromboelastometry could assess an hypercoagulable state in surgical neoplastic patients. Patients and Methods: Fifty consecutive patients with carcinoma of the digestive tract in preoperative period (23 M, 27 F aging 61.5 (45–79 years) and 147 healthy subjects (71 M, 76 F) were studied. A recent thromboelastometric method based on thrombelastography after Hartert was employed. Measurements were performed on ROTEM Coagulation Analyzer. The con- tinuous coagulation data from 50 min course were transformed into dynamic velocity profiles of WB clot formation. Results: Standard parameters (CT, CFT, MCF) of cancer patients were similar to controls. CT (in cancer patients): females 50 s (38.3–58.7), males 50 s (42–71.2) vs 51 s (42–59), p = 0.1210 / 53 s (42–74.8), p = 0.1975 (in controls). CFT (in cancer patients): females 72 s (32- 92.4), males 80 s (50.2- 128.7) vs 78 s (62–100), p = 0.0128 / 80 s (59–124.4), p = 0.9384 (in controls). MCF (in cancer patients): females 70 mm (59.9–82.5), males 63 mm (56–73.7) vs 69 mm (59–95.8), p = 0.9911 / 69 mm (53.6–90), p = 0.0135 (in controls). Females showed a higher MaxVel when compared to males. The MaxVel was increased in cancer patients: females 19 mm /100 s (14.3–49.5) males 18 mm / 100 s (11–27) vs 15 mm 100 s (11.8–22), p < 0.001 / 13 mm / 100 s (10–21.8), p < 0.001 in controls .The t-MaxVel was shortened in cancer patients: females 65 s (48.6–112.8), males 81 s (50.1–135.9) vs 115 s (56.8–166), p <0.001 / 115 s (59.8–180.8), p = 0.0002 in controls. The AUC was increased in cancer patients: females 6451 mm 100 (5511–8148), males 5984 mm 100 (5119- 6899) vs 5778 mm 100 (4998–6655), p < 0.001 / 5662 mm 100 (4704–6385), p = 0.0105. Conclusion: Unlike other assays measuring variations in a single component during coagulation, the thrombelastographic method records a profile of real-time continuous WB clot formation, and may provide extensive informations on haemostasis in neoplastic patients before surgery. Key Words: cancer, thromboelastography, hypercoagulable state, thromboelastometry, surgery. Received: May 11, 2007. Correspondence: E-mail: domenico.delucia@unina2.it Abbreviations used: ��C �� area under curve�� C�� clottin��C �� area under curve�� C�� clottin��C�� clottin�� formation time�� CP� �� cancer procoa��ulant�� C�� clottin�� time�� MC� �� maximum clot firmness�� P�Rs �� proteases activated re- ceptors�� tissue factor�� V��E �� venous thromboembolism. Exp Oncol �� Experimental Oncology �� ne�� for the occ�rrence of the thrombotic events in one in- divid�al patient [�]. Since reliable methods�� that co�ld have a higher predictive val�e for thrombosis risk�� are needed�� o�r aim is to get better informations eval�ating the profile of extended time coag�lation analysis. Th�s�� the investigation of coag�lation dynamics in whole blood co�ld�� in o�r opinion�� disclose an abnormal pattern in cancer patients�� especially in those at increased throm- botic risk. C�rrent laboratory clotting techniq�es cannot f�lly identify s�bjects with an increased thromboembolic risk: their performance in plasma and the addition of b�ffered sol�tions limit their relevance to overall dynamic clot formation in whole blood [��]. In contrast ROTEM thrombelastometry specifically assess overall coag�la- tion kinetics and strength in whole blood�� providing a global assessment of haemostatic f�nction [��]. Therefore the aim of this st�dy was to investi- gate whether an hypercoag�lable state�� revealed by ROTEM�� can be an important variable to eval�ate the coag�lation derangements in patients affected by cancer of the digestive tract. maTerials and meThods Patients. �� patients with histologically confirmed solid cancer of the digestive tract were st�died. �3 were male�� were female and all aging 6�.� �4�� years��. The criteria for incl�sion in the st�dy have been: patients with a carcinoma of the digestive tract witho�t history of VTE who were candidate for s�rgery. �4�� healthy s�bjects �� M�� 6 F�� selected on the basis of sex and age were enrolled in o�r st�dy as control gro�p. The st�dy was approved by Ethics Committee of the Instit�te. Informed consent was collected from all participants. Sample collection. Blood samples were drawn be- tween 8 am and � am�� after �� h of fasting. The blood �nine vol�mes�� was placed in t�bes with �.�� M of trisodi�m citrate �one vol�me�� ntil analysis. Test procedure. A recent thromboelastometric method �ROTEM®; Pentapharm Ltd�� M�nich�� Ger- many; distrib�ted in Italy by Dasit�� Milano�� based on the thrombelastography after Hartert��was employed [��]. Meas�rements were performed on a ROTEM Coag�lation Analyzer. Citrated blood samples were recalcified with CaCl� �star-TEM®�� reagent�� and ac- tivated with tiss�e thromboplastin from rabbit brain �ex-TEM�� reagent�� for monitoring the extrinsic system. The ROTEM® analysis determines the onset of the coag�lation process: clotting time �CT��; the kinetics of clotting formation and stability: clotting formation time �CFT�� and maxim�m clot firmness �MCF�� Fig. �� a��. The ROTEM® software also calc�lates the novel pa- rameters according to Sorensen [�4] s�ch as MaxVel�� t-MaxVel�� AUC by data derived from the ROTEM c�rve. MaxVel describes the maxim�m velocity of the clot formation. It is the maxim�m rate of clot formation�� the maxim�m of the one derivative c�rve. t-MaxVel describes the time from start of the mea- s�rement till MaxVel �maxim�m of the one derivative�� is reached. It is a parameter similar to CT. AUC describes the area �nder the velocity �one derivative�� c�rve and is eq�ivalent to MCF in a c�rve where the test had been r�n till MCF had been reached [�4] �Fig. �� b��. fig. 1, a. Standard thrombelastographic tracking �CT�� CFT�� MCF�� fig. 1, b. ROTEM c�rve displayed by ROTEM Gamma software Velocity profile�� the first derivative of the ROTEM tracking: maxi- m�m velocity �MaxVel�� time to maxim�m velocity �t-MaxVel�� area �nder c�rve �AUC�� from Sorensen [�3] Statistical analysis. Statistical significance of the differences of val�es between patients and the healthy controls was calc�lated by the Mann — Whitney U test. The differences were considered statistically signifi- cant only for p-val�es less �.�� Tables �� . Table 1. RO��EM standard parameters in neoplastic patients and in healthy reference subjects Healthy Males Median 5P 95P p value Patients Males Median 5P 95P C�� 53 42 74,8 0.1975 C�� 50 42 71,2 C�� 80 59 122,4 0.9384 C�� 80 50,2 128,7 MC� 69 53,6 90 0.0135 MC� 63 56 73,7 Healthy �emales Patients �emales C�� 51 42 59 0.1210 C�� 50 38,3 58,7 C�� 78 62 100 0.0128 C�� 72 32 92,4 MC� 69 59 95,8 0.9911 MC� 70 59,9 82,5 Medians and reference ran��e (5��95% percentile ) for controls and pa- tients. Table 2. RO��EM velocity parameters in neoplastic patients and in healthy reference subjects Healthy Males Median 5P 95P p value Patient Males Median P5 P95 MaxV 13 10 21,8 0.001 MaxV 18 11 27 MaxV-t 115 59.8 180.8 0.0002 MaxV-t 81 50.1 135.9 ��C 5662 4703.6 6385 0.0105 ��C 5984 5118.7 6899.2 Healthy �emales Patients �emales MaxV 15 11.8 22 0.001 MaxV 19 14.3 49.5 MaxV-t 115 56.8 166 0.001 MaxV-t 65 48.6 112.8 ��C 5778 4998 6655 0.001 ��C 6451 5514.8 8148.4 Medians and reference ran��e (5��95% percentile) for controls and for patients. Experimental Oncology �� ne�� 3�� ne�� 3��ne�� 3�� 3 ��3 resulTs Standard parameters of ROTEM �CT�� CFT�� MCF�� were not different in cancer patients as compared to controls. CT �in cancer patients��: females �� s �38.3��8.�� males �� s �4��.�� vs �� s �4�� p = �.��/�3 s �4��4.8�� p = �.�� in controls��. CFT �in cancer patients��: females �� s �3��.4�� males 8� s ��.��8.�� vs ��8 s �6�� p = �.��8 / 8� s ��4.4�� p = �.�384 �in controls��. MCF �in cancer patients��: females �� mm ��.��8�.�� males 63 mm ��6��3.�� vs 6� mm ��.8�� p = �.��/ 6� mm ��3.6�� p = �.��3� �in controls��. The analysis showed: an increase in MCF in male controls as compared to patients and a shorter CFT in female patients than in controls �Table ��. The contin�o�s coag�lation data from a �� min-time co�rse were transformed into dynamic velocity profiles of WB clot formation [�4] �Fig. ��. fig. 2, a, b, c, d, e, f. �box plot��: medians and reference range ��% percentile�� of MaxVel�� t-Max Vel�� AUC for controls and patients There were higher MaxVel in female controls as compared to male controls. The res�lts were in accordance with earlier st�dies [��]. The ROTEM® velocity parameters res�lted significantly different in patients when compared to the parameters of healthy s�bjects. The MaxVel was increased �cancer patients��: females �� mm ��/ s ��4.3�4�.�� males �8 mm ��/ s �� vs �� mm ��/s ��.8�� p <�.��/�3 mm ��/s ��.8�� p < �.�� controls��. The t- MaxVel was shortened �cancer patients��: females 6� s �48.6� ��.8�� males 8� s ��.��3�.�� vs �� s ��6.8��66�� p < �.��/�� s ��.8��8�.8�� p = �.�� controls��. The AUC was increased �cancer patients��: females 64�� mm �� 8�48�� males ��84 mm �� 68�� vs ��8 mm �� 4��8�66�� p < �.��/�66� mm �� 4��4�638�� p = �.�� con- trols�� Table ��. discussion Reliable markers and methods to predict thrombo- tic risk are essential to clinical management�� especially for high- risk patients�� i. e.�� cancer patients �ndergoing therape�tic interventions. Most laboratory tests act�- ally �sed for st�dying haemostasis are performed on platelet-poor plasma with clotting [��] or chromogenic [�6] end points. Nowadays�� thanks to a better �nder- standing of the role of platelets�� le�kocytes and eryth- rocytes in the clotting process�� to eval�ate thrombin generation d�ring blood coag�lation has become the best approach in order to assess the global complex process [��]. However�� whereas thrombin generation tests are diffic�lt to perform in real time clinical prac- tice [�8]�� thrombelastographic recording of the whole blood coag�lation process is anticipated to indirectly reflect the co�rse of thrombin generation .The classical thrombelastography prod�ces a profile of the overall rheological changes occ�rring d�ring coag�lation and in the past it has been prevalently �sed to assist clinicians in the control of after-s�rgery bleeding. A newer modification of classical thrombelastography is thromboelastometry �ROTEM®�� which avoids some technical limitations of the traditional method�� s�ch as sensitivity to vibrations or mechanical shocks. ROTEM �ses a ball bearing system for power transd�ction which makes it easily transportable and less s�scep- tible to mechanical stress�� movement and vibration. F�rthermore�� the activation of the samples accelerates the meas�rement process and enhances reprod�cibil- ity compared with conventional thromboelastography [��]. The data obtained whit this new techniq�e are contin�o�s�� digital and retrievable for f�rther calc�la- tions; by processing of data the thrombelastographic time co�rse can be transformed into a dynamic veloc- ity profile of the changes in blood elasticity occ�rring d�ring WB clot formation. The instr�ments software is �sed to calc�late three new parameters in the assess- ment of coag�lation dynamic properties. The pattern of the new val�es: MaxVel�� t-MaxVel�� AUC�� display a remarkable degree of similarity between endogeno�s thrombin potential �thrombogram�� and thrombelasto- graphic model. Therefore the profile of whole blood coag�lation by thrombelastography�� as an indirect meas�re of thrombin generation�� may provide exten- sive informations on haemostasis�� not only for the clini- cal management of bleeding b�t also for thrombophilic states [��]. In vivo markers of coag�lation activation �prothrombin fragment � + � / F� + �� and fibrinolysis �tiss�e plasminogen activator /t-PA�� correlate very well ��4 Experimental Oncology �� ne�� with ROTEM® clotting time �CT�� and maximal lysis �ML�� in a validation of rotation thrombelastography model of systemic activation of coag�lation and fibrinolysis [��]. TEG has been s�ccessf�lly �sed in clinical setting to detect hypercoag�lable states. A postoperative hy- percoag�lable state�� as revealed by TEG�� was associa- ted with thrombotic complications in a wide gro�p of s�rgical patients followed d�ring postoperative period �ntil discharge [�3]. fig. 3. Velocity profiles of WB clot formation before s�rgery in neo- plastic patients and in healthy s�bjects. �a�� Healthy male s�bject �red�� and male patient �green�� velocity profile �b��. Healthy female s�bject �red�� and female patient �green�� velocity profile The correlation between thrombotic complications and hypercoag�lability confirms that s�rgical patients are at high risk for hypercoag�lability and that this plays an important role in the pathogenesis of thrombosis. In patients affected by malignant disease�� thrombosis is the most freq�ent complication and the second ca�se of death [�4]. S�rgical interventions in these patients increase the risk of postoperative VTE �approximately two-three fold�� in comparison to the risk in non-can- cer patients �ndergoing the same proced�res. The American College of Chest Physicians �ACCP�� has stratified patients with malignancy in the highest risk category of s�rgical patients and �rged ro�tine throm- boprophylaxis [��]. Therefore�� especially for high-risk patients�� it is strongly desirable to �se a one’s disposal test characterized by a higher predictive val�e of the thrombotic event. Thrombelastography represents a val�able method which monitors haemostasis �nder low shear environ- ment as a whole dynamic process instead of revealing information on isolated parts of the different linked path- ways. Indeed thromboelastometry provides information abo�t the whole process of clot formation which res�lts from interdependent steps: coag�lation activation�� thrombin prod�ction�� fibrin formation and polymeriza- tion�� platelet activation�� platelet-fibrin interaction. In concl�sion�� the �se of thrombelastometric method has red�ced the need of s�bstit�tive therapies for the clinical management of bleeding problems d�r- ing major s�rgical interventions �liver transplantations�� cardiovasc�lar proced�res�� ne�ros�rgery�� [�6]. Final- ly�� the a�thors feel that the diagnosis of hypercoag�- lable state by �sing thromboelastometry�� in patients at higher thrombotic risk �especially cancer patients d�ring s�rgery�� co�ld provide a rationale for more targeted prophylactic antithrombotic treatments. acknowledgemenTs This st�dy was f�nded with grants in aid from DASIT S. p. A Milno. Italy. We thank Dr. M. Lakner �Pentapharm GmbH�� Germany�� and Dr. V. Scala �Dasit S. p. A�� Italy�� for their contrib�tions to the st�dy. The a�thors thankThe a�thors thank also Dr Danilo Petraccaro on behalf of PC FIREWIRE Society�� Naples�� Italy�� e-mail: pcfirewire@j�mpy.it�� for his s�pport on technical and graphic works. references 1. Bloom JW, Doggen CGM, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations and risk of venous thrombosis. JAMA 2005; 293: 715–22. 2. Mannucci PM. The measurement of multifactorial thrombophilia. Thromb Haemost 2002; 88: 1–2. 3. Falanga A, Gordon SG. 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ТромбоэласТография как меТод оценки риска Тромбоза при опухолях пищевариТельного ТракТа Предпосылки исследования:: �� , �� , �� п��пух��й ��п��й, ��ь�� ю�� п�� д��-��у��, ��щ�щ�ющ�х ��ь�� й ��э�� (VTE) � �� п�� . �� д�� -VTE) � �� п�� . �� д�� -) � �� п�� . �� д�� - � �� п�� . �� д�� -� �� п�� . �� д�� -. �� д�� -�� д�� - �� у�� п��й �� у ��д�� д��ь�� п��. �� д� �� ю� �� д��; �� д� �� ю� �� д��;�� д� �� ю� �� д��; ��д� �� ю� �� д��;��д� �� ю� �� д��; �� ю� �� д��;�� ю� �� д��; �� ю� �� д��;�� ю� �� д��; �� ю� �� д��;�� ю� �� д��; �� ю� �� д��;�� ю� �� д��; ��ю� �� д��;��ю� �� д��; �� д��;�� д��; �� д��;�� д��; д��;д��;; ��, ��д ��э�� д�� ь �п�� ь ��у �� ., ��д ��э�� д�� ь �п�� ь ��у �� .��д ��э�� д�� ь �п�� ь ��у �� . ��э�� д�� ь �п�� ь ��у �� .��э�� д�� ь �п�� ь ��у �� . д�� ь �п�� ь ��у �� .д�� ь �п�� ь ��у �� . ��ь �п�� ь ��у �� .��ь �п�� ь ��у �� . �п�� ь ��у �� .�п�� ь ��у �� . ��ь ��у �� .��ь ��у �� . ��у �� .��у �� . �� .�� . �� .�� . � ��.� ��. ��.��.. Цель: �п��д��ь, � ��й �� ь ��у��, �п��д��й ��д�� э��, �� э��, �� , �� п�� у ��ь��х �� п�� п�� х��у�� ш��ь��. Пациенты и мето�ето� ды: ��д�� 50 ��ь��х �� п�щ��ь�� д��п��й п��д (27 ��щ��, 23 �у��, ��д��й�� п�щ��ь�� д��п��й п��д (27 ��щ��, 23 �у��, ��д��й п�щ��ь�� д��п��й п��д (27 ��щ��, 23 �у��, ��д��й �� 61,5 ��д� (45–79 ��) � 147 �д��х д�� (71 �у��, 76 ��щ��). �� д ��э��,. �� д ��э��, ��й �� э�� Г��, � ��п��ь�� у�� ROTEM. ��ущ�� д��ROTEM. ��ущ�� д�� ущ�� д�� 50 �� й п��д�� д� д��х п��й �� п�� у�� . Результаты: ��д�� п�� (п��д ��у�� (CT), п��д �� у�� (CFT), ��ь�� п��-��д�� п�� (п��д ��у�� (CT), п��д �� у�� (CFT), ��ь�� п��- (п��д ��у�� (CT), п��д �� у�� (CFT), ��ь�� п��-п��д ��у�� (CT), п��д �� у�� (CFT), ��ь�� п��-CT), п��д �� у�� (CFT), ��ь�� п��-), п��д �� у�� (CFT), ��ь�� п��-, п��д �� у�� (CFT), ��ь�� п��-п��д �� у�� (CFT), ��ь�� п��-CFT), ��ь�� п��-), ��ь�� п��-, ��ь�� п��-��ь�� п��- ��ь ��у�� (MCF)) ��ь��х �� п�� ь��. CT у ��ь��х �� п��MCF)) ��ь��х �� п�� ь��. CT у ��ь��х �� п��) ��ь��х �� п�� ь��. CT у ��ь��х �� п�� ь��х �� п�� ь��. CT у ��ь��х �� п��ь��х �� п�� ь��. CT у ��ь��х �� п��. CT у ��ь��х �� п��у ��ь��х �� п�� ь��х �� п��ь��х �� п�� : у ��щ�� 50 � (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59),: у ��щ�� 50 � (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59),у ��щ�� 50 � (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59), 50 � (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59),� (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59), (38,3–58,7), у �у�� 50 � (42–71,2) vs 51 � (42–59),у �у�� 50 � (42–71,2) vs 51 � (42–59), �� 50 � (42–71,2) vs 51 � (42–59),�� 50 � (42–71,2) vs 51 � (42–59),50 � (42–71,2) vs 51 � (42–59),� (42–71,2) vs 51 � (42–59), (42–71,2) vs 51 � (42–59),� (42–59), (42–59), p = 0,1210/53 � ( 42–74,8 ),0,1210/53 � ( 42–74,8 ),� ( 42–74,8 ), ( 42–74,8 ), p = 0,1975 0,1975 � ��ь��й ��упп�. CFT у ��х п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs. CFT у ��х п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vsу ��х п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs ��х п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs��х п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs п�� : у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs��: у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs: у ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vsу ��щ�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs �� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs�� 72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs72 � ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs� ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs ( 32–92,4) у �у�� – 80 � (50,2–128,7) vs) у �у�� – 80 � (50,2–128,7) vs у �у�� – 80 � (50,2–128,7) vsу �у�� – 80 � (50,2–128,7) vs – 80 � (50,2–128,7) vs� (50,2–128,7) vs(50,2–128,7) vs 78 � (62–100), p = 0,0128 / 80 � (59–124,4),� (62–100), p = 0,0128 / 80 � (59–124,4), (62–100), p = 0,0128 / 80 � (59–124,4), = 0,0128 / 80 � (59–124,4), 0,0128 / 80 � (59–124,4), / 80 � (59–124,4),/ 80 � (59–124,4), 80 � (59–124,4),80 � (59–124,4),� (59–124,4), (59–124,4), p = 0,9384 � ��ь��й ��упп�. MCF у ��ь��х �� п�� 0,9384 � ��ь��й ��упп�. MCF у ��ь��х �� п�� ь��й ��упп�. MCF у ��ь��х �� п��. MCF у ��ь��х �� п��у ��ь��х �� п�� ь��х �� п��ь��х �� п�� п�� п�� : у ��щ�� 70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),: у ��щ�� 70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),у ��щ�� 70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8), �� 70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),�� 70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),70 �� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),�� (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8), (59,9–82,5), у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8),у �у�� 63 �� (56–73,7) vs 69 �� (59–95,8), �� 63 �� (56–73,7) vs 69 �� (59–95,8),�� 63 �� (56–73,7) vs 69 �� (59–95,8),63 �� (56–73,7) vs 69 �� (59–95,8),�� (56–73,7) vs 69 �� (59–95,8), (56–73,7) vs 69 �� (59–95,8),�� (59–95,8), (59–95,8), p = 0,9911 / 69 �� (53,6–90), 0,9911 / 69 �� (53,6–90),�� (53,6–90), (53,6–90), p = 0,0135 � ��ь��й ��упп�. �� щ�� п�� MaxVel �� ш�, �� у �у��. �� 0,0135 � ��ь��й ��упп�. �� щ�� п�� MaxVel �� ш�, �� у �у��. ��,0135 � ��ь��й ��упп�. �� щ�� п�� MaxVel �� ш�, �� у �у��. ��0135 � ��ь��й ��упп�. �� щ�� п�� MaxVel �� ш�, �� у �у��. �� ь��й ��упп�. �� щ�� п�� MaxVel �� ш�, �� у �у��. ��. �� щ�� п�� MaxVel �� ш�, �� у �у��. �� щ�� п�� MaxVel �� ш�, �� у �у��. �� п�� MaxVel �� ш�, �� у �у��. ��п�� MaxVel �� ш�, �� у �у��. �� MaxVel �� ш�, �� у �у��. �� MaxVel �� ш�, �� у �у��. ��MaxVel �� ш�, �� у �у��. �� ш�, �� у �у��. ��. �� MaxVel п��ш�� у ��х п��: у ��щ�� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /п��ш�� у ��х п��: у ��щ�� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /: у ��щ�� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /у ��щ�� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� / �� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /�� 19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /19 ��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /��/100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /100 � (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /� (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� / (14,3–49,5) у �у�� 18 ��/100 � (11–27 ) vs 15 �� /у �у�� 18 ��/100 � (11–27 ) vs 15 �� / �� 18 ��/100 � (11–27 ) vs 15 �� /�� 18 ��/100 � (11–27 ) vs 15 �� /18 ��/100 � (11–27 ) vs 15 �� /��/100 � (11–27 ) vs 15 �� /100 � (11–27 ) vs 15 �� /� (11–27 ) vs 15 �� / (11–27 ) vs 15 �� /�� / 100 � (11,8–22),� (11,8–22), (11,8–22), p < 0,001 / 13 �� / 100 � (10–21,8),�� / 100 � (10–21,8), / 100 � (10–21,8),/ 100 � (10–21,8),100 � (10–21,8), � (10–21,8), (10–21,8), p <0,001 � ��ь��й ��упп�. ��ь t-MaxVel п�� у� ��ь��й ��упп�. ��ь t-MaxVel п�� у. ��ь t-MaxVel п�� у ��ь t-MaxVel п�� уt-MaxVel п�� у-MaxVel п�� уMaxVel п�� у п�� у ��ь��х �� п��: у ��щ�� – 65 � (48,6–112,8) , у �у�� – 81 � (50,1–135,9) vs 115 � (56,8–166),vs 115 � (56,8–166), 115 � (56,8–166), p < 0,001 / 115 � (59,8–180,8), p = 0,0002 � ��ь��й ��упп�. ��ь AUC у п��ш�� у ��щ�� 6451 �� 100AUC у п��ш�� у ��щ�� 6451 �� 100 у п��ш�� у ��щ�� 6451 �� 100 (5511–8148), у �у�� 5984 �� 100 (5119–6899) vs 5778 �� 100 (4998–6655),vs 5778 �� 100 (4998–6655), 5778 �� 100 (4998–6655), p < 0,001 / 5662 �� 100 (4704–6385), p = 0.0105. Выводы:: � �� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д�у��х ��д��, ��ющ�х �� д��ь��х ��п�� д��, ��ющ�х �� д��ь��х ��п�� д��, ��ющ�х �� д��ь��х ��п�� , ��ющ�х �� д��ь��х ��п�� ющ�х �� д��ь��х ��п�� д��ь��х ��п�� д��ь��х ��п�� д��ь��х ��п�� д��ь��х ��п�� п�� п�� , ��д ��э�� ущ�й п��ь �� у�� ь�� , ��д ��э�� ущ�й п��ь �� у�� ь�� д ��э�� ущ�й п��ь �� у�� ь�� э�� ущ�й п��ь �� у�� ь�� э�� ущ�й п��ь �� у�� ь�� ущ�й п��ь �� у�� ь�� ущ�й п��ь �� у�� ь�� ущ�й п��ь �� у�� ь�� ущ�й п��ь �� у�� ь�� п��ь �� у�� ь�� п��ь �� у�� ь�� у�� ь�� у�� ь�� у�� ь�� у�� ь�� ь�� ь�� ь�� ь�� ь�� ь�� п�� у ��х ��ь��х. �п�� у ��х ��ь��х.�п�� у ��х ��ь��х. �� у ��х ��ь��х.�� у ��х ��ь��х. �� у ��х ��ь��х.�� у ��х ��ь��х. �� у ��х ��ь��х.�� у ��х ��ь��х. у ��х ��ь��х.у ��х ��ь��х. ��х ��ь��х.��х ��ь��х. ��ь��х.��ь��х.. Ключевые слова: слова:слова:: ��, ��э��, �� п��у��, ��э��, х��у��.��, ��э��, �� п��у��, ��э��, х��у��., ��э��, �� п��у��, ��э��, х��у��.��э��, �� п��у��, ��э��, х��у��., �� п��у��, ��э��, х��у��.�� п��у��, ��э��, х��у��. ��п��у��, ��э��, х��у��.��п��у��, ��э��, х��у��., ��э��, х��у��.��э��, х��у��..

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