Hypofibrinolysis as a major factor risk of thromboembolic events in cancer patients

Introduction: The frequency of venous thromboembolic complications (VTEC) in cancer patients increased by 10% during chemotherapy. The combination of systemic hypercoagulation and hypofibrinolysis are the most dangerous risk factors of VTEC.

Aim of this study was to evaluate the parameters of thromboelastography (hypercoagulation and hypofibrinolisis) to assess the impact of the use of low molecular weight heparin.

Methods: We studied 78 cancer patients (women - 47, average age - 56 years) before chemotherapy with a high risk of VTEC according to Khorana scale (≥3 points). Blood tests were taken before and 3-4 hours after injection of LMWH (dalteparin sodium 5000 IU per day). The following parameters of thromboelastography were studied (TEG 5000, USA): R - the start of the reaction (our modification, RF patent №2015515, normal values = 660-970), fibrinolysis (our modification, RF patent №2358657, normal values = 60-120%). To evaluate the complex interaction of these two parameters, we decided to introduce a point scoring: 1 point when the parameter R was less than 500 seconds and 1 point when fibrinolysis was lower 40%. In case of reduction of these parameters above the a/n values we began therapy with LMWH.

Results: Before the use of LMWH 38% of cancer patients had moderate/expressed hypercoagulation (mean score = 0.5), and 80% - moderate/expressed inhibition of fibrinolysis (average score = 0.95); total score was 1.45. Therefore, inhibition of fibrinolysis is a leading risk factor for VTEC in cancer patients. At the peak of the action of LMWH total score decreased by 64% (p <0.01). In 10% of patients with total score = 1.0, we increased dose up to 5000 IU LMWH x 2 times per day. As a result, the control of tromboelastography parameters showed a reduction of total score by 14% of the initial value. Thus, additional drug correction of the hemostatic system and fibrinolysis reduced total score by 78% of the initial value.

Conclusion: Hypofibrinolysis is a major risk factor of VTEC development. Combined evaluation of hypercoagulation and hypofibrinolysis allows a better assessment of the risk of VTEC in cancer patients. The proposed parameters of thromboelastography are the most appropriate for the evaluation of LMWH antithrombotic effect.

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