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Alexander ET, Gilmour SK. Immunomodulatory role of thrombin in cancer progression. Mol Carcinog 2022; 61:527-536. [PMID: 35338515 DOI: 10.1002/mc.23398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/06/2022]
Abstract
Coagulation proteases and the generation of thrombin are increased in tumors. In addition, chemotherapeutic agents commonly used to treat malignant cancers can exacerbate cancer-associated thromboses. Thrombin can modify tumor cell behavior directly through the activation of protease-activated receptors (PAR) or indirectly by generating fibrin matrices. In addition to its role in generating fibrin to promote hemostasis, thrombin acts directly on multiple effector cells of the immune system impacting both acute and chronic inflammatory processes. Thrombin-mediated release of interleukin-6, tumor necrosis factor-α, and monocyte chemoattractant protein-1 leads to the accumulation of multiple tumor-infiltrating immunosuppressive cell populations including myeloid derived suppresser cells, M2-like macrophages, and T regulatory cells. Ablation of PAR-1 from the tumor microenvironment, but not the tumor, has been shown to dramatically reduce tumor growth and metastasis in multiple tumor models. Thrombin-activated platelets release immunosuppressive cytokines including transforming growth factor-β that can inhibit natural killer cell activity, helping tumor cells to evade host immunosurveillance. Taken together, there is strong evidence that thrombin influences cancer progression via multiple mechanisms, including the tumor immune response, with thrombin emerging as a target for novel therapeutic strategies for cancer.
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Affiliation(s)
- Eric T Alexander
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Susan K Gilmour
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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Michalski W, Poniatowska G, Jonska-Gmyrek J, Kucharz J, Stelmasiak P, Nietupski K, Ossolinska-Skurczynska K, Sobieszczuk M, Demkow T, Wiechno P. Venous thromboprophylaxis in urological cancer surgery. Med Oncol 2019; 37:11. [PMID: 31768889 DOI: 10.1007/s12032-019-1331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
Venous thromboembolism (VTE) represents a major complication of cancer and its treatment, contributing to increased morbidity and mortality. The appropriate choice of thromboprophylaxis method and duration is, therefore, of utmost importance. We conducted an extensive review of the literature concerning VTE in patients undergoing surgery for urological cancers. Special attention was paid to risk factors, different types of surgery (transurethral, pelvic, abdominal-open, laparoscopic and robot-assisted) and different medications used (heparins, vitamin K antagonists and new oral anticoagulants). Original papers, reviews and guidelines were identified in Medline database. The available data were then summarised for the purpose of this article. Venous thromboprophylaxis is obligatory in urological cancer patients undergoing surgical treatment. Unless individual contraindications are recognised, the available guidelines should be followed. The variety of clinical scenarios and patients' comorbidities necessitate cooperation with other specialists (cardiologists, neurologists, etc.) in choosing the optimal management. Thrombosis risk must be carefully weighed against bleeding risk.
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Affiliation(s)
- Wojciech Michalski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland.
| | - Pawel Stelmasiak
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Katarzyna Ossolinska-Skurczynska
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Michal Sobieszczuk
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Pawel Wiechno
- Department of Uro-Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Poland, 5, Roentgen Street, 02-781, Warsaw, Poland
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Harsfalvi J, Molnar Z, Csanyi MC, Domjan I, Flasko T, Kaposi A, Benyo M. Long-lasting prothrombotic state implied by changes of plasma von Willebrand factor parameters after radical prostatectomy for prostate malignancy. Urol Oncol 2019; 38:191-197. [PMID: 31711834 DOI: 10.1016/j.urolonc.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Thromboembolic complications are present in 0.8%-16.8% of the cases after radical prostatectomy (RP). Association between elevated plasma von Willebrand factor (VWF) levels-as an endothelial activation marker-and increased risk of thrombotic events has been evidenced. We aimed to elicit new data on the VWF after RP in prostate cancer patients and explore the role of it as a thrombotic risk factor. Upon perioperative plasma VWF levels (VWF:Ag) its collagen-binding (CB) activity (VWF:CB), multimerization, and cleaving enzyme (ADAMTS13 [a disintegrin and metalloprotease with thrombospondin type repeats, motif 1, type 13]) of the VWF multimers were quantitated along with Factor VIII and routine laboratory parameters in this observational pilot study. METHODS Plasma samples of 24 prostate cancer patients were collected before (-1 day; D-1) and after RP (1 hour, 6 days, 1 month, and 10 months; H1, D6, M1, and M10). VWF:Ag, VWF:CB, ADAMTS13:Ag were measured by ELISA, and the multimer distribution by electrophoresis and quantitative densitometry. Factor VIII, fibrinogen, D-dimer, and other routine laboratory parameters were determined as well. Preoperative values served as baselines which were compared to controls (24 healthy individuals). RESULTS VWF:Ag and CB elevated by 122% and 143% respectively at H1 after RP then plateaued at D6 compared to baseline values. ADAMTS13/VWF:Ag ratio reduced by 41% at H1, and by 46% at D6, meanwhile the ratio of high molecular weight multimers increased as well. Values returned to baseline at M1 and further reduced to the levels of the controls at M10. All of the 24 patients at H1 and D6 and 14 at M10 were in potential prothombotic state according ROC analysis of the VWF parameters as indicators. CONCLUSIONS Prostate malignancy and then surgical stress, and inflammatory reactions induced release of VWF from the endothelial cells, along with an increasing amount of large multimers and relative reduction of ADAMTS13 level. Because these changes mark a prothrombotic state even at M1 after RP, more than 1 month follow-up and prophylactic targeting through the thrombotic and inflammatory activity of the VWF is proposed. Evaluation of VWF parameters provides new information about the long-term disturbances of primary hemostasis after radical pelvic oncologic surgery like RP and might improve the understanding the physiological and pathological recovery.
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Affiliation(s)
- Jolan Harsfalvi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
| | - Zsuzsanna Molnar
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Laboratory, Grof Tisza Istvan Hospital, Berettyoujfalu, Hungary
| | - Maria Cs Csanyi
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Istvan Domjan
- Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Urology, Josa Andras Hospital, Hospitals of Szabolcs-Szatmar-Bereg County, Nyiregyhaza, Hungary
| | - Tibor Flasko
- Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andras Kaposi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Matyas Benyo
- Department of Laboratory, Grof Tisza Istvan Hospital, Berettyoujfalu, Hungary; Department of Urology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Thrombin Generation and Cancer: Contributors and Consequences. Cancers (Basel) 2019; 11:cancers11010100. [PMID: 30654498 PMCID: PMC6356447 DOI: 10.3390/cancers11010100] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/19/2022] Open
Abstract
The high occurrence of cancer-associated thrombosis is associated with elevated thrombin generation. Tumour cells increase the potential for thrombin generation both directly, through the expression and release of procoagulant factors, and indirectly, through signals that activate other cell types (including platelets, leukocytes and erythrocytes). Furthermore, cancer treatments can worsen these effects. Coagulation factors, including tissue factor, and inhibitors of coagulation are altered and extracellular vesicles (EVs), which can promote and support thrombin generation, are released by tumour and other cells. Some phosphatidylserine-expressing platelet subsets and platelet-derived EVs provide the surface required for the assembly of coagulation factors essential for thrombin generation in vivo. This review will explore the causes of increased thrombin production in cancer, and the availability and utility of tests and biomarkers. Increased thrombin production not only increases blood coagulation, but also promotes tumour growth and metastasis and as a consequence, thrombin and its contributors present opportunities for treatment of cancer-associated thrombosis and cancer itself.
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Rottenstreich A, Elazary R, Yuval JB, Spectre G, Kleinstern G, Kalish Y. Assessment of the procoagulant potential after laparoscopic sleeve gastrectomy: a potential role for extended thromboprophylaxis. Surg Obes Relat Dis 2018; 14:1-7. [DOI: 10.1016/j.soard.2017.09.526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/03/2017] [Accepted: 09/23/2017] [Indexed: 11/26/2022]
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Selmeczi A, Roach REJ, Móré C, Batta Z, Hársfalvi J, Bom van der JG, Boda Z, Oláh Z. Thrombin generation and low-molecular-weight heparin prophylaxis in pregnant women with thrombophilia. Thromb Haemost 2017; 113:283-9. [DOI: 10.1160/th14-05-0452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/03/2014] [Indexed: 11/05/2022]
Abstract
SummaryPregnancy is associated with increased risk of venous thromboembolism, especially in the presence of thrombophilia. However, there is no consensus on the optimal approach for thromboprophylaxis in this population. Recent evidence suggests that thrombin generation correlates with the overall procoagulant state of the plasma. Our aim was to evaluate thrombin generation in a prospective cohort of thrombophilic pregnant women, and investigate the effectiveness of low-molecular- weight heparin (LMWH) prophylaxis in pregnancy. Women with severe (n=8), mild (n=47) and no (n=15) thrombophilia were followed throughout their pregnancies. Thrombin generation was evaluated in each trimester as well as five days and eight weeks postpartum (as a reference category). In women undergoing LMWH prophylaxis, thrombin generation and anti-Factor-Xa activity were measured just before and 4 hours after administration (peak effect). Thrombin generation was determined using Technothrombin TGA assay system. For the analysis, median peak thrombin and endogenous thrombin potential were used. Peak thrombin and endogenous thrombin potential were increased during pregnancy compared to the non-pregnant state with the highest results in the severe thrombophilia group. In women receiving LMWH prophylaxis a decrease was observed in thrombin generation at peak effect but over the progression of pregnancy the extent of this decrease reduced in a stepwise fashion. Our results show that thrombin generation demonstrates the hypercoagulable state in thrombophilic pregnancies. In addition, we found the effect of LMWH prophylaxis to progressively decrease with advancing stages of pregnancy.
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John A, Gorzelanny C, Bauer AT, Schneider SW, Bolenz C. Role of the Coagulation System in Genitourinary Cancers: Review. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30210-0. [PMID: 28822718 DOI: 10.1016/j.clgc.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/30/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022]
Abstract
Tumor progression is associated with aberrant hemostasis, and patients with malignant diseases have an elevated risk of developing thrombosis. A crosstalk among the vascular endothelium, components of the coagulation cascade, and cancer cells transforms the intravascular milieu to a prothrombotic, proinflammatory, and cell-adhesive state. We review the existing evidence on activation of the coagulation system and its implication in genitourinary malignancies and discuss the potential therapeutic benefit of antithrombotic agents. A literature review was performed searching the Medline database and the Cochrane Library for original articles and reviews. A second search identified studies reporting on oncological benefit of anticoagulants in genitourinary cancer. An elevated expression of procoagulatory tissue factor on tumor cells and tumor-derived microparticles seems to stimulate cancer development and progression. Several components of the hemostatic system, including D-dimers, von Willebrand Factor, thrombin, fibrin-/ogen, soluble P-selectin, and prothrombin fragments 1 + 2 were either overexpressed or overactive in genitourinary cancers. Hypercoagulation was in general associated with a poorer prognosis. Experimental models and small trials in humans showed reduced cancer progression after treatment with anticoagulants. Main limitations of these studies were heterogeneous experimental methodology, small patient numbers, and a lack of prospective validation. In conclusion, experimental and clinical evidence suggests procoagulatory activity of genitourinary neoplasms, particularly in prostate, bladder and kidney cancer. This may promote the risk of vascular thrombosis but also metastatic progression. Clinical studies linked elevated biomarkers of hemostasis with poor prognosis in patients with genitourinary cancers. Thus, anticoagulation may have a therapeutic role beyond prevention of thromboembolism.
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Affiliation(s)
- Axel John
- Department of Urology, Ulm University Medical Centre, Ulm, Germany; Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Christian Gorzelanny
- Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Dermatology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander T Bauer
- Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan W Schneider
- Department of Dermatology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Bolenz
- Department of Urology, Ulm University Medical Centre, Ulm, Germany
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Sassi M, Chakroun T, Mbemba E, Van Dreden P, Elalamy I, Larsen AK, Gerotziafas GT. The Antithrombotic Potential of Tinzaparin and Enoxaparin Upon Thrombin Generation Triggered In Vitro by Human Ovarian Cancer Cells IGROV1. Clin Appl Thromb Hemost 2016; 23:155-163. [PMID: 27609342 DOI: 10.1177/1076029616665922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A documented relationship between ovarian cancer and thrombosis does exist. Low-molecular-weight heparins (LMWHs) are cornerstone drugs in the primary prevention and treatment of venous thromboembolic events in patients with cancer. However, cancer cells may alter the efficiency of these antithrombotic agents. OBJECTIVE We aimed to characterize the procoagulant phenotype of human epithelial ovarian adenocarcinoma cells, IGROV1, and to compare the capacity of tinzaparin and enoxaparin to inhibit thrombin generation triggered by these cells. METHODS Thrombin generation induced by different concentrations of IGROV1 cells on platelet poor plasma (PPP) was assessed by the calibrated automated thrombogram assay. Tissue factor (TF) expression was studied using Western blot analysis. Then, the experimental model of thrombin generation was used to compare the inhibitory effect of clinically relevant concentrations of both tinzaparin and enoxaparin. The inhibitory concentration 50 (IC50) of the mean rate index and the endogenous thrombin potential and the 2-fold increase in lag time were analyzed on the basis of the anti-Xa and anti-IIa activities of the LMWHs. RESULTS IGROV1 cells suspended into PPP resulted in a significant increase in thrombin generation in the absence of any exogenous source of TF and phospholipids. Tissue factor was expressed by IGROV1 cells. Tinzaparin was a more potent inhibitor of thrombin generation than enoxaparin. The inhibition of thrombin generation induced by IGROV1 cancer cells depended mainly on the anti-Xa activity of the LMWHs. CONCLUSION This experimental study in ovarian cancer cells demonstrates that the antithrombotic activity of LMWHs is not completely predicted by the anti-Xa or anti-IIa activities measured in PPP.
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Affiliation(s)
- Mouna Sassi
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,2 Laboratoire de Biologie, Centre de Maternité et de Néonatologie, Hôpital Fattouma Bourguiba, Monastir, Tunisia
| | - Taher Chakroun
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,3 Centre Régional de Transfusion Sanguine, Sousse, Tunisia
| | - Elisabeth Mbemba
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Patrick Van Dreden
- 4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France
| | - Ismail Elalamy
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France.,5 Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Annette K Larsen
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Grigoris T Gerotziafas
- 1 Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, Institut National de la Santé et de la Recherche Médicale (INSERM) U938, Sorbonne Universities, Université Pierre et Marie Curie (UPMC), Paris, France.,4 Clinical Research Department, Diagnostica Stago, Gennevilliers, France.,5 Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
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Hu W, Wang X, Yang R. Evaluation of D-dimer and lactate dehydrogenase plasma levels in patients with relapsed acute leukemia. Oncol Lett 2016; 12:591-596. [PMID: 27347185 DOI: 10.3892/ol.2016.4657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/16/2016] [Indexed: 11/06/2022] Open
Abstract
Despite the outstanding advances made over the past decade regarding our knowledge of acute leukemia (AL), relapsed AL remains to be associated with a dismal prognosis. A better understanding of AL relapse and monitoring of the D-dimer and lactate dehydrogenase (LDH) plasma levels following chemotherapy may aid clinicians in determining whether relapse may occur in the subsequent phases of the disease. The present study evaluated D-dimer and LDH levels in 204 patients with relapsed AL. Data were collected at the initial onset of AL, at complete remission (CR) and in patients with relapsed AL. D-dimer plasma levels were significantly increased in patients with initial AL and in patients with relapsed AL (P=0.005 and P=0.007, respectively) but not in those with CR. LDH levels were significantly increased in AL patients at the initial onset of disease and at relapse compared with patients achieving CR, irrespective of cell type. Plasma prothrombin time, activated partial thromboplastin time and fibrinogen levels were not significantly different across patients (with the exception of acute promyelocytic leukemia patients) at the initial onset, relapsed AL or CR. Routine hematological parameters (white blood cell count, hemoglobin, platelet count) were significantly different at the initial onset of AL (P=0.002, P<0.001 and P=0.001, respectively) and during relapsed AL (P=0.009, P=0.003 and P<0.001, respectively) compared with patients achieving CR, suggesting an association between D-dimer, LDH and relapsed AL. These results also indicate that determination of D-dimer and LDH levels may be useful for predicting the probability of relapse during chemotherapy, but should also be combined with routine hematological parameters.
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Affiliation(s)
- Wangqiang Hu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaoxia Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Rongrong Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Helin TA, Lemponen M, Hjemdahl P, Rönquist-Nii Y, Lassila R, Joutsi-Korhonen L. From laboratory to clinical practice: Dabigatran effects on thrombin generation and coagulation in patient samples. Thromb Res 2015; 136:154-60. [DOI: 10.1016/j.thromres.2015.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 04/07/2015] [Accepted: 04/24/2015] [Indexed: 02/05/2023]
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Benyo M, Harsfalvi J, Pfliegler G, Molnar Z, Muranyi M, Jozsa T, Flasko T. Present Practice of Thrombosis Prophylaxis of Radical Prostatectomy in a European Country: A Hungarian Multicenter Study. Urol Int 2014; 92:289-93. [DOI: 10.1159/000353918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/19/2013] [Indexed: 11/19/2022]
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