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Thrombin Generation and D-Dimer for Prediction of Disease Progression and Mortality in Patients with Metastatic Gastrointestinal Cancer. Cancers (Basel) 2022; 14:cancers14184347. [PMID: 36139507 PMCID: PMC9496981 DOI: 10.3390/cancers14184347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: the tight and reciprocal interaction between cancer and hemostasis has stimulated investigations on the possible role of hemostatic biomarkers in predicting specific cancer outcomes, such as disease progression (DP) and overall survival (OS). In a prospective cohort of newly diagnosed metastatic gastrointestinal (GI) cancer patients from the HYPERCAN study, we aimed to assess whether the hemostatic biomarker levels measured before starting any anticancer therapy may specifically predict for 6-months DP (6m-DP) and for 1-year OS (1y OS). Methods: plasma samples were collected and tested for thrombin generation (TG) as global hemostatic assay, and for D-dimer, fibrinogen, and prothrombin fragment 1 + 2 as hypercoagulation biomarkers. DP and mortality were monitored during follow-up. Results: A prospective cohort of 462 colorectal and 164 gastric cancer patients was available for analysis. After 6 months, DP occurred in 148 patients, providing a cumulative incidence of 24.8% (21.4−28.4). D-dimer and TG endogenous thrombin potential (ETP) were identified as independent risk factors for 6m-DP by multivariate Fine−Gray proportional hazard regression model corrected for age, cancer site, and >1 metastatic site. After 1 year, we observed an OS of 75.7% (71.9−79.0). Multivariate Cox regression analysis corrected for age, site of cancer, and performance status identified D-dimer and ETP as independent risk factors for 1y OS. Patients with one or both hemostatic parameters above the dichotomizing threshold were at higher risk for both 6m-DP and 1-year mortality. Conclusion.: in newly diagnosed metastatic GI cancer patients, pretreatment ETP and D-dimer appear promising candidate biomarkers for predicting 6m-DP and 1y OS. In this setting, for the first time, the role of TG as a prognostic biomarker emerges in a large prospective cohort.
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2
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Carlo A, Yan Q, Ten Cate H, De Laat-Kremers R, De Laat B, Ninivaggi M. Semi-automated thrombin dynamics applying the ST Genesia thrombin generation assay. Front Cardiovasc Med 2022; 9:912433. [PMID: 35958413 PMCID: PMC9360406 DOI: 10.3389/fcvm.2022.912433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/30/2022] [Indexed: 01/15/2023] Open
Abstract
Background The haemostatic balance is an equilibrium of pro- and anticoagulant factors that work synergistically to prevent bleeding and thrombosis. As thrombin is the central enzyme in the coagulation pathway, it is desirable to measure thrombin generation (TG) in order to detect possible bleeding or thrombotic phenotypes, as well as to investigate the capacity of drugs affecting the formation of thrombin. By investigating the underlying processes of TG (i.e., prothrombin conversion and inactivation), additional information is collected about the dynamics of thrombin formation. Objectives To obtain reference values for thrombin dynamics (TD) analysis in 112 healthy donors using an automated system for TG. Methods TG was measured on the ST Genesia, fibrinogen on the Start, anti-thrombin (AT) on the STA R Max and α2Macroglobulin (α2M) with an in-house chromogenic assay. Results TG was measured using STG-BleedScreen, STG-ThromboScreen and STG-DrugScreen. The TG data was used as an input for TD analysis, in combination with plasma levels of AT, α2M and fibrinogen that were 113% (108-118%), 2.6 μM (2.2 μM-3.1 μM) and 2.9 g/L (2.6-3.2 g/L), respectively. The maximum rate of the prothrombinase complex (PCmax) and the total amount of prothrombin converted (PCtot) increased with increasing tissue factor (TF) concentration. PCtot increased from 902 to 988 nM, whereas PCmax increased from 172 to 508 nM/min. Thrombin (T)-AT and T-α2M complexes also increased with increasing TF concentration (i.e., from 860 to 955 nM and from 28 to 33 nm, respectively). PCtot, T-AT and T-α2M complex formation were strongly inhibited by addition of thrombomodulin (-44%, -43%, and -48%, respectively), whereas PCmax was affected less (-24%). PCtot, PCmax, T-AT, and T-α2M were higher in women using oral contraceptives (OC) compared to men/women without OC, and inhibition by thrombomodulin was also significantly less in women on OC (p < 0.05). Conclusions TG measured on the ST Genesia can be used as an input for TD analysis. The data obtained can be used as reference values for future clinical studies as the balance between prothrombin conversion and thrombin inactivation has shown to be useful in several clinical settings.
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Affiliation(s)
- Audrey Carlo
- Diagnostica Stago S.A.S., Asnières-sur-Seine, France
| | - Qiuting Yan
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands.,Department of Biochemistry, Maastricht University, Maastricht, Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Maastricht University, Maastricht, Netherlands
| | - Romy De Laat-Kremers
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands.,Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
| | - Bas De Laat
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands.,Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
| | - Marisa Ninivaggi
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
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3
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High levels of von Willebrand factor with reduced specific activities in hospitalized patients with or without COVID-19. J Thromb Thrombolysis 2022; 54:211-216. [PMID: 35881214 PMCID: PMC9314532 DOI: 10.1007/s11239-022-02679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic is often accompanied by severe respiratory illness and thrombotic complications. Von Willebrand Factor (VWF) levels are highly elevated in this condition. However, limited data are available on the qualitative activity of VWF in COVID-19. We measured plasma VWF levels quantitatively (VWF antigen) and qualitatively (ristocetin-induced platelet agglutination, glycoprotein IbM (GPIbM) binding, and collagen binding). Consistent with prior reports, VWF antigen levels were significantly elevated in hospitalized patients with or without COVID-19. The GPIbM and collagen binding activity-to-antigen ratios were significantly reduced, consistent with qualitative changes in VWF in COVID-19. Of note, critically ill hospitalized patients without COVID-19 had similar reductions in VWF activity-to-antigen ratios as patients with COVID-19. Our data suggest that qualitative changes in VWF in COVID-19 may not be specific to COVID-19. Future studies are warranted to determine the mechanisms responsible for qualitative changes in VWF in COVID-19 and other critical illnesses.• VWF levels were increased in COVID-19 compared to healthy controls.• VWF activity-to-antigen ratios were decreased in COVID-19 compared to healthy controls.• There were no differences in VWF activity-to-antigen ratios between hospitalized patients with or without COVID-19.• These findings are consistent with qualitative changes in VWF in systemic inflammation which are not specific to COVID-19.• Future studies are needed to define possible roles of changes in conformation or multimer length in the qualitative changes in VWF in systemic inflammation.
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4
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Marchetti M, Russo L, Giaccherini C, Gamba S, Falanga A. Hemostatic system activation in breast cancer: Searching for new biomarkers for cancer risk prediction and outcomes. Thromb Res 2022; 213 Suppl 1:S46-S50. [DOI: 10.1016/j.thromres.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/17/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
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5
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Londero AP, Bertozzi S, Cedolini C, Neri S, Bulfoni M, Orsaria M, Mariuzzi L, Uzzau A, Risaliti A, Barillari G. Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery. Cancers (Basel) 2022; 14:cancers14040988. [PMID: 35205736 PMCID: PMC8870485 DOI: 10.3390/cancers14040988] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 01/04/2023] Open
Abstract
Albeit it does not have the highest venous thromboembolism (VTE) incidence compared to other neoplasms, breast cancer contributes to many VTE events because it is the most diagnosed tumor in women. We aim to analyze the occurrence and timing of VTE during the follow-up of patients who underwent breast surgery, the possible correlated factors, and the overall survival. This retrospective study included all female patients diagnosed with mammary pathology and surgically treated in our clinic between January 2002 and January 2012. Of 5039 women who underwent breast surgery, 1056 were found to have no evidence of malignancy, whereas 3983 were diagnosed with breast cancer. VTE rate resulted significantly higher in patients with invasive breast cancer than in women with benign breast disease or carcinoma in situ. Invasive cancers other than lobular or ductal were associated with a higher VTE rate. In addition, chronic hypertension, high BMI, cancer type, and evidence of metastasis turned out to be the most significant risk factors for VTE in women who underwent breast surgery. Moreover, VTE occurrence significantly impacted survival in invasive breast cancer patients. Compared to women with benign mammary pathology, VTE prevalence in women with breast cancer is significantly higher. The knowledge about the risk factors of VTE could be helpful as prognostic information, but also to eventually target preventive treatment strategies for VTE, as far as the co-existence of invasive breast cancer and VTE has a significantly negative impact on survival.
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Affiliation(s)
- Ambrogio P. Londero
- Academic Unit of Obstetrics and Gynaecology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Correspondence: (A.P.L.); (S.B.)
| | - Serena Bertozzi
- Ennergi Research (Non-Profit Organisation), 33050 Lestizza, Italy
- Breast Unit, University Hospital of Udine, 33100 Udine, Italy;
- Correspondence: (A.P.L.); (S.B.)
| | - Carla Cedolini
- Breast Unit, University Hospital of Udine, 33100 Udine, Italy;
| | - Silvia Neri
- Clinic of Surgery, University Hospital of Udine, 33100 Udine, Italy; (S.N.); (A.R.)
| | - Michela Bulfoni
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
| | - Maria Orsaria
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
| | - Laura Mariuzzi
- Institute of Pathologic Anatomy, University Hospital of Udine, 33100 Udine, Italy; (M.B.); (M.O.); (L.M.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Alessandro Uzzau
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Andrea Risaliti
- Clinic of Surgery, University Hospital of Udine, 33100 Udine, Italy; (S.N.); (A.R.)
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy;
| | - Giovanni Barillari
- Center for Hemorrhagic and Thrombotic Diseases, ASUFC “Santa Maria della Misericordia”, 33100 Udine, Italy;
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Abstract
Hyperactivation of the complement and coagulation systems is recognized as part of the clinical syndrome of COVID-19. Here we review systemic complement activation and local complement activation in response to the causative virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their currently known relationships to hyperinflammation and thrombosis. We also provide an update on early clinical findings and emerging clinical trial evidence that suggest potential therapeutic benefit of complement inhibition in severe COVID-19.
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Affiliation(s)
- Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Marina Noris
- Istituto di Ricerche Farmacologiche "Mario Negri", Clinical Research Center for Rare Diseases "Aldo e Cele Daccò", Ranica, Italy.
- "Centro Anna Maria Astori", Bergamo, Italy.
| | - Bart N Lambrecht
- Laboratory of Immunoregulation and Mucosal Immunology, VIB-UGent Center for Inflammation Research, Ghent, Belgium.
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
| | - Claudia Kemper
- Complement and Inflammation Research Section (CIRS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany.
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Pestana RM, Duarte RC, Alves MT, de Oliveira AN, Oliveira HH, Soares CE, de P. Sabino A, Silva LM, das Graças Carvalho M, Simões R, Gomes KB. Hemostatic status in women with breast cancer and cardiotoxicity associated to doxorubicin-based chemotherapy – A one-year follow-up study. Thromb Res 2022; 211:56-59. [DOI: 10.1016/j.thromres.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
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8
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Moik F, Prager G, Thaler J, Posch F, Wiedemann S, Schramm T, Englisch C, Mackman N, Pabinger I, Ay C. Hemostatic Biomarkers and Venous Thromboembolism Are Associated With Mortality and Response to Chemotherapy in Patients With Pancreatic Cancer. Arterioscler Thromb Vasc Biol 2021; 41:2837-2847. [PMID: 34470475 DOI: 10.1161/atvbaha.121.316463] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Florian Moik
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Gerald Prager
- Clinical Division of Oncology (G.P.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Johannes Thaler
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Florian Posch
- Division of Haematology, Department of Internal Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Austria (F.P.)
| | - Sarah Wiedemann
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Theresa Schramm
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Cornelia Englisch
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Nigel Mackman
- Division of Hematology, Department of Medicine, UNC Blood Research Center, University of North Carolina at Chapel Hill (N.M.)
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology (F.M., J.T., S.W., T.S., C.E., I.P., C.A.), Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria.,I. M. Sechenov First Moscow State Medical University, Russia (C.A.)
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9
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Falanga A, Marchetti M, Russo L. Hemostatic Biomarkers and Cancer Prognosis: Where Do We Stand? Semin Thromb Hemost 2021; 47:962-971. [PMID: 34450680 DOI: 10.1055/s-0041-1733925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer patients are characterized by hypercoagulable state and an increased rate of thrombotic events, the most common being venous thromboembolism. Several hemostatic pathways that are significantly implicated in mechanisms of thromboembolic disease are also involved in growth, invasion, and metastatic spread of malignant cells as well in tumor-induced neo-angiogenesis. This close connection between cancer and the hemostatic system has prompted numerous studies on the role of alterations in the level plasma biomarkers of the different compartments of hemostasis in predicting cancer prognosis. In this review, we collect the results of several exemplificative studies that have evaluated clotting activation biomarkers in relation to different cancer outcomes with a final emphasis on current research and forthcoming directions in this field.
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Affiliation(s)
- Anna Falanga
- Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Marina Marchetti
- Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Division of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
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