BACKGROUND: Although venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients, the etiology of hypercoagulability in malignancy remains poorly understood. We investigated whether aberrant levels of hemostatically and endothelially active molecules that are produced endogenously and by tumor cells are associated with VTE in malignancy. PATIENTS/METHODS: Plasma levels of von Willebrand factor (vWF), thrombin-antithrombin complex (TAT), protein C, prothrombin fragment 1+2, tissue plasminogen activator, plasminogen activator inhibitor (PAD, tissue factor, platelet-derived growth factor alpha-beta, and basic fibroblast growth factor were determined in patients with cancer and acute deep vein thrombosis (DVT) (case group, n=36), acute DVT but no cancer (DVT control group, n=60), and cancer but no DVT (cancer control group, n=32) recruited from among four McGill University affiliated hospitals. Patients with recent surgery, trauma, pregnancy, chemotherapy, or anticoagulant therapy were excluded. Clinical data on age, sex, prior DVT, recent blood transfusion, HRT/OCP use, smoking, hepatic or renal dysfunction, cancer type, and evidence of métastases were collected by chart review. RESULTS: With the main exceptions of sex and transaminase elevation, the study groups were wellmatched with regard to clinical data collected. Analyses of laboratory data, adjusted for age and sex, revealed that mean vWF was significantly greater in the case group than in both the cancer and DVT control groups (3.6U/ml vs. 2.2U/ml and 2.4U/ml; p=.01 and p=.009, respectively) and mean PAI was signficantly lower in the case group than the cancer control group (33.4ng/ml vs. 36.9ng/ml; p=.004). In addition, median TAT was significantly greater in the case group as compared to either the cancer or DVT control groups (19.Ing/ml vs. 9.4ng/ml and 4.6ng/ml; p=.001 and p<.0001, respectively). CONCLUSIONS: Our results show that VTE in cancer patients is associated with elevated vWF and TAT levels and reduced PAI levels. Further prospective study is warranted to determine whether elevated vWF and TAT levels and reduced PAI levels serve as markers to predict the development of DVT in malignancy and, hence, help define those cancer patients who may benefit from prophylactic anticoagulation.
|Original language||English (US)|
|Issue number||11 PART I|
|State||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology