Effects of malignancy on blood coagulation in septic intensive care patients

Abstract

: The objectives of the study are to examine the effect of sepsis on the coagulation profile of patients having solid cancer and to test the hypothesis that septic patients with cancer have normal or increased hemostatic capacity despite prolonged standard coagulation tests (SCTs) compared with noninfected cancer patients. Patients with solid cancer were included in the study forming two groups: study group included patients with sepsis with minimum two organ dysfunctions and control group formed by noninfected cancer patients. SCTs, platelet count, plasma levels of coagulation factors and rotation thromboelastometry (TEM International GmbH, Munich, Germany) were determined in both groups. Study group patients (n = 35) showed prolonged SCTs, thrombocytopenia, decreased coagulation factor levels and increased D-dimer compared with control group (n = 35). However, fibrinogen levels and clot firmness assessed by rotation thromboelastometry were not different between groups and clot lysis indexes at 45 and 60 min were increased in study group compared with control group. The first derivative of the clot firmness curve revealed an increased time to the maximum velocity of clot formation for study group, without differences in the maximum velocity of clot formation, or in total thrombus formation. Sepsis with organ dysfunction in cancer patients is associated with delayed initiation of coagulation and reduced fibrinolysis compared with control patients, but overall clot formation and stabilization is not different. For septic cancer patients, SCTs and plasmatic indicators of fibrinolysis do not translate well to whole blood clot formation and may be misleading indicators of thrombotic or bleeding risk.

Clinical Study of Quyuhuazhuo on Reducing Blood Hypercoagulability of Malignant Tumors

“…Hypercoagulability is common in patients with malignant tumor [6]. Tumor cells can damage the vascular endothelium, strengthen the adhesion, aggregation and activation of platelets, secrete procoagulant substances, reduce anticoagulant activity, inhibit the activation of fibrinolytic system, and cause hypercoagulable state [7].…”

Compensatory effect of fibrinogen in a patient with bone marrow aplasia, septic shock, and severe thrombocytopenia guided by thromboelastometry: a case report

“…Massion et al proposed that the increased fibrinogen concentration in septic patients may explain the discrepancy between low platelet levels and normal maximum clot firmness in thromboelastometry by compensating for thrombocytopenia or for decreased coagulation factor activity. ( 13 , 14 )…”

Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients

“…To our knowledge, few studies have shown the utility of derived ROTEM parameters in assessing coagulation kinetics. These parameters are beginning to be used in septic patients with multiple system organ failure with promising results [13]. Solomon et al [14] demonstrated that clot elasticity and clot firmness did not follow a linear correlation and that the use of clot elasticity could prove to offer a more significant insight into clot strength.…”