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Hamza MS, Mousa SA. Cancer-Associated Thrombosis: Risk Factors, Molecular Mechanisms, Future Management. Clin Appl Thromb Hemost 2021; 26:1076029620954282. [PMID: 32877229 PMCID: PMC7476343 DOI: 10.1177/1076029620954282] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a major health problem in patients with cancer. Cancer augments thrombosis and causes cancer-associated thrombosis (CAT) and vice versa thrombosis amplifies cancer progression, termed thrombosis-associated cancer (TAC). Risk factors that lead to CAT and TAC include cancer type, chemotherapy, radiotherapy, hormonal therapy, anti-angiogenesis therapy, surgery, or supportive therapy with hematopoietic growth factors. There are some other factors that have an effect on CAT and TAC such as tissue factor, neutrophil extracellular traps (NETs) released in response to cancer, cancer procoagulant, and cytokines. Oncogenes, estrogen hormone, and thyroid hormone with its integrin αvβ3 receptor promote angiogenesis. Lastly, patient-related factors can play a role in development of thrombosis in cancer. Low-molecular-weight heparin and direct oral anticoagulants (DOACs) are used in VTE prophylaxis and treatment rather than vitamin K antagonist. Now, there are new directions for potential management of VTE in patients with cancer such as euthyroid, blockade of thyroid hormone receptor on integrin αvβ3, sulfated non-anticoagulant heparin, inhibition of NETs and stratifying low and high-risk patients with significant bleeding problems with DOACs.
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Affiliation(s)
- Marwa S. Hamza
- Clinical Pharmacy Practice Department, Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt
- The Center for Drug Research and Development (CDRD), Faculty of Pharmacy, The British University in Egypt, Cairo, Egypt
| | - Shaker A. Mousa
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
- Shaker A. Mousa, PhD, The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144, USA.
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Dong XF, Kong FZ, Shen MQ, Huang J, Gao ZE, Guo QZ, Zhao Z, Luo WF, Cheng QZ, Wu GH. Triiodothyronine levels were positively correlated with opening of collateral circulation in cerebral infarction patients with large artery atherosclerosis. Arch Med Sci 2020; 16:51-57. [PMID: 32051705 PMCID: PMC6963139 DOI: 10.5114/aoms.2020.91286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Non-thyroidal illness syndrome (NTIS) is one of the signs for poor prognosis of cerebral infarction (CI), but its risk factors had never been explored. In this study, we analyzed the potential effect of collateral circulation on prognosis prediction of triiodothyronine for large artery atherosclerosis cerebral infarction (LAA-CI) patients. MATERIAL AND METHODS Clinical data of CI patients between 2012 and 2014 were collected. Imaging inspection was used for determining TOAST classification and evaluating collateral circulation. One-year follow-up was conducted for mRS score by telephone. RESULTS T3 level in the NTIS group (p = 0.001) was significantly decreased while TSH level (p < 0.001) was increased. Patients in the NTIS group had a poorer prognosis (p = 0.008) and the main reason was the high mortality (p = 0.002). NTIS predicted poor collateral circulation (p = 0.026) and good collateral circulation tended to be less likely concomitant with NTIS (p = 0.001). Logistic regression analysis showed that triiodothyronine concentrations (OR = 4.760, 95% CI: 1.981-11.456, p < 0.001) were positively correlated with but advanced age (OR = 0.756, 95% CI: 0.645-0.886, p = 0.001) negatively with opening of collateral circulation. CONCLUSIONS Poor opening of collateral circulation was likely to mediate the prediction of NTIS for prognosis of LAA-CI patients.
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Affiliation(s)
- Xiao-Feng Dong
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Fan-Zhen Kong
- Department of Psychology, Suzhou Guangji Hospital, Suzhou Psychiatric Hospital, Suzhou, China
| | - Ming-Qiang Shen
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jiang Huang
- Ophthalmology Department, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zong-En Gao
- Neurology Department, Shengli Oilfield Central Hospital, Suzhou, China
| | - Qian-Zhu Guo
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Zhong Zhao
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Wei-Feng Luo
- Neurology Department, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing-Zhang Cheng
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Guan-Hui Wu
- Neurology Department, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
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Bano A, Chaker L, de Maat MPM, Atiq F, Kavousi M, Franco OH, Mattace-Raso FUS, Leebeek FWG, Peeters RP. Thyroid Function and Cardiovascular Disease: The Mediating Role of Coagulation Factors. J Clin Endocrinol Metab 2019; 104:3203-3212. [PMID: 30938758 DOI: 10.1210/jc.2019-00072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/27/2019] [Indexed: 12/31/2022]
Abstract
CONTEXT Mechanisms linking high and high-normal thyroid function to increased cardiovascular risk remain unclear. Hypothetically, coagulation can play a role. OBJECTIVE To investigate (i) the association of thyroid function with coagulation factors and (ii) whether coagulation factors mediate the association of thyroid function with cardiovascular disease (CVD). DESIGN AND SETTING Rotterdam Study, a population-based prospective study. PARTICIPANTS AND MAIN OUTCOME MEASURES In 5918 participants (mean age, 69.1 years), we measured TSH, free T4 (FT4), and coagulation factors [von Willebrand factor antigen (VWF:Ag), ADAMTS13 activity, fibrinogen]. Participants were followed up for the occurrence of cardiovascular events and deaths. Associations of thyroid function with coagulation factors (standardized z scores) and CVD were assessed through linear regression and Cox proportional hazards models, adjusted for potential confounders. We performed causal mediation analyses to evaluate whether the effect of thyroid function on CVD is mediated by coagulation. RESULTS Higher FT4 levels were associated with higher VWF:Ag (β = 0.34; 95% CI = 0.22, 0.47), lower ADAMTS13 activity (β = -0.22; 95%CI = -0.35, -0.09), and higher fibrinogen (β = 0.26; 95% CI = 0.13, 0.39); 857 incident cardiovascular events and 690 cardiovascular deaths occurred. FT4 levels were positively associated with cardiovascular events and deaths. The effect of FT4 on incident cardiovascular events was minimally mediated by fibrinogen (1.6%) but not by VWF:Ag and ADAMTS13. VWF:Ag and fibrinogen together mediated 10.0% of the effect of FT4 on cardiovascular deaths. CONCLUSIONS Higher FT4 levels were associated with higher VWF:Ag, lower ADAMTS13 activity, and higher fibrinogen levels, indicating a procoagulant state. VWF:Ag and fibrinogen explained up to 10% of the link between FT4 and CVD.
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Affiliation(s)
- Arjola Bano
- Department of Internal Medicine, Netherlands Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Layal Chaker
- Department of Internal Medicine, Netherlands Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ferdows Atiq
- Department of Hematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Frank W G Leebeek
- Department of Hematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Netherlands Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
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Elbers LPB, Fliers E, Cannegieter SC. The influence of thyroid function on the coagulation system and its clinical consequences. J Thromb Haemost 2018; 16:634-645. [PMID: 29573126 DOI: 10.1111/jth.13970] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 11/29/2022]
Abstract
Several studies indicate that low plasma levels of thyroid hormone shift the hemostatic system towards a hypocoagulable and hyperfibrinolytic state, whereas high levels of thyroid hormone lead to more coagulation and less fibrinolysis. Low levels of thyroid hormone thereby seem to lead to an increased bleeding risk, whereas high levels, by contrast, increase the risk of venous thromboembolism. Hypothyroidism leads to a higher incidence of acquired von Willebrand's syndrome and with increasing levels of free thyroxine, levels of fibrinogen, factor VIII and von Willebrand factor, amongst others, increase gradually, to the extent that they may lead to symptomatic venous thromboembolism in patients with hyperthyroidism. Here, we discuss the literature on the effect of thyroid hormone on the hemostatic system and the associated risk of bleeding and venous thromboembolism. Patients with hypothyroidism are at increased risk of developing bleeding complications, which could be relevant in patients undergoing invasive procedures. Furthermore, physicians should be aware of the possibility of hyperthyroidism as an underlying risk factor for venous thromboembolism, especially in unexplained cases. Clinical studies are needed to further investigate the significance for general practice of these findings. Besides the effects of hyperthyroidism on venous thromboembolism, its effects on embolism secondary to atrial fibrillation are described.
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Affiliation(s)
- L P B Elbers
- Department of Internal Medicine, MC Slotervaart, Amsterdam, the Netherlands
| | - E Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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Ahirwar AK, Singh A, Jain A, Kaim K, Bhardwaj S, Patra SK, Goswami B, Bhatnagar M, Bhattacharjee J. Association of prothrombotic adipokine (plasminogen activator inhibitor-1) with TSH in metabolic syndrome: a case control study. Horm Mol Biol Clin Investig 2017; 34:hmbci-2017-0046. [DOI: 10.1515/hmbci-2017-0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/06/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Metabolic syndrome (MetS) involves a cluster of cardiovascular risk factors, including abnormal lipids, insulin resistance and hypertension. The aim of the present study is to investigate associations between thyroid profile and the pro-thrombotic mediator, plasminogen activator inhibitor-1 (PAI-1), in MetS and identify associated biochemical markers.
Materials and methods
The present study was a case control study and consisted of 50 diagnosed cases of MetS and 50 healthy volunteers as controls. MetS cases were further divided into two groups based on the presence and absence of subclinical hypothyroidism (SCH). Data collected included demographic profile, clinical history and routine lab investigation. Special investigations included the thyroid function test and serum PAI-1 levels.
Results
The mean serum thyroid-stimulating hormone (TSH) levels were significantly higher in MetS cases as compared to controls (5.7 ± 1.2 mIU/L vs. 2.3 ± 1.6 mIU/L, p < 0.0001), although the mean triiodothyronine (T3) and thyroxine (T4) levels were comparable in two groups. The mean levels of serum PAI-1 were significantly higher in MetS cases as compared to controls(231 ± 87 ng/mL vs. 185 ± 96 ng/mL, p = 0.013). TSH and PAI-1 levels were positively correlated with various markers of MetS and negatively correlated with high-density lipoprotein (HDL).
Conclusion
The present study points towards the presence of thyroid dysfunction, in the form of subclinical hypothyroidism (SCH), in cases of MetS. In the presence of thyroid dysfunction, abnormal adipocytes may release adipokines, such as PAI-1, which lead to increased risk of thrombotic episodes in these patients. Hence, SCH should be appropriately managed.
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Affiliation(s)
- Ashok Kumar Ahirwar
- Department of Biochemistry , All India Institute of Medical Sciences (AIIMS) , Room no. 3013, Third Floor, Teaching Block, AIIMS, Ansari Nagar , New Delhi-110029 , India , Phone: +919654210832
| | - Archana Singh
- Department of Biochemistry , All India Institute of Medical Sciences (AIIMS) , New Delhi-110029 , India
| | - Anju Jain
- Department of Biochemistry , Lady Hardinge Medical College (LHMC) , New Delhi , India
| | - Kirti Kaim
- Department of Ophthalmology , Deen Dayal Upadhyay Hospital , New Delhi , India
| | - Shilpa Bhardwaj
- Department of Biochemistry , Rajiv Gandhi Super Speciality Hospital , New Delhi , India
| | - Surajeet Kumar Patra
- Department of Biochemistry , Lady Hardinge Medical College (LHMC) , New Delhi , India
| | - Binita Goswami
- Department of Biochemistry , Maulana Azad Medical College , New Delhi , India
| | - M.K. Bhatnagar
- Department of Biochemistry , Lady Hardinge Medical College (LHMC) , New Delhi , India
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Elbers LPB, Moran C, Gerdes VE, van Zaane B, Meijers J, Endert E, Lyons G, Chatterjee VK, Bisschop PH, Fliers E. The Hypercoagulable state in Hyperthyroidism is mediated via the Thyroid Hormone β Receptor pathway. Eur J Endocrinol 2016; 174:EJE-15-1249. [PMID: 26961801 PMCID: PMC7613030 DOI: 10.1530/eje-15-1249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hyperthyroidism is associated with a hypercoagulable state, but the underlying mechanism is unknown. Patients with resistance to thyroid hormone (RTH) due to defective thyroid hormone receptor β (TRβ) exhibit elevated circulating thyroid hormones (TH) with refractoriness to TH action in TRβ-expressing tissues. We tested the hypothesis that the hypercoagulable state in hyperthyroidism is mediated via the TRβ. DESIGN We conducted a cross-sectional study from November 2013 to January 2015 in 3 hospitals in the Netherlands and the United Kingdom. METHODS Patients with RTH due to defective TRβ (n=18), patients with hyperthyroidism (n=16) and euthyroid subjects (n=18) were included. TH concentrations and markers of coagulation and fibrinolysis were measured. Data are expressed as median [interquartile range]. RESULTS Free thyroxine (FT4) levels were slightly higher in hyperthyroid patients than in RTH patients (53.9 [30.5-70.0] and 34.9 [28.4-42.2]pmol/l, respectively, P=0.042). Both groups had raised FT4 levels compared to euthyroid subjects (14.0 [13.0-15.8] pmol/l, P≤0.001). Levels of von Willebrand factor (VWF), factor (F) VIII, fibrinogen, and D-dimer were significantly higher in hyperthyroid patients than in RTH patients (VWF 231 [195-296] vs. 111 [82-140]%, FVIII 215 [192-228] vs. 145 [97-158]%, fibrinogen 3.6 [3.0-4.4] vs. 2.8 [2.5-3.2]g/L, D-dimer 0.41 [0.31-0.88] vs. 0.20 [0.17-0.26]mg/L, respectively, P≤0.001), while there were no differences between RTH patients and euthyroid controls. CONCLUSIONS Parameters of coagulation and fibrinolysis were elevated in hyperthyroid patients compared to patients with RTH due to defective TRβ, whereas these parameters were not different between euthyroid controls and RTH patients, despite elevated FT4 concentrations in RTH patients. This indicates that the procoagulant effects observed in hyperthyroidism are mediated via the TRβ.
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Affiliation(s)
- Laura P B Elbers
- L Elbers, Internal Medicine, Medical Center Slotervaart, Amsterdam, Netherlands
| | - Carla Moran
- C Moran, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Victor Ea Gerdes
- V Gerdes, Internal Medicine, Medical Center Slotervaart, Amsterdam, Netherlands
| | - Bregje van Zaane
- B van Zaane, Internal Medicine, Medical Center Slotervaart, Amsterdam, Netherlands
| | - Joost Meijers
- J Meijers, Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Erik Endert
- E Endert, Laboratory of Endocrinology and Radiochemistry, Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Greta Lyons
- G Lyons, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - V Krishna Chatterjee
- V Chatterjee, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Peter H Bisschop
- P Bisschop, Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Eric Fliers
- E Fliers, Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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